Lower Extremity Limb Salvage with Cross Leg Pedicle Flap, Cross Leg Free Flap, and Cross Leg Vascular Cable Bridge Flap

Oscar J. Manrique; Sarah N. Bishop; Pedro Ciudad; Kian Adabi; Jorys Martinez-Jorge; Steven L. Moran; Tony Huang; Aparna Vijayasekaran; Shih-heng Chen; Hung-chi Chen

doi:10.1055/s-0038-1641712

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2018; 34(07): 522-529
DOI: 10.1055/s-0038-1641712

Original Article

Lower Extremity Limb Salvage with Cross Leg Pedicle Flap, Cross Leg Free Flap, and Cross Leg Vascular Cable Bridge Flap

Authors

Oscar J. Manrique

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Sarah N. Bishop

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Pedro Ciudad

²Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan, ROC

³Department of Biological Science and Technology, China Medical University, Taichung, Taiwan, ROC
Kian Adabi

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Jorys Martinez-Jorge

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Steven L. Moran

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Tony Huang

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Aparna Vijayasekaran

¹Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
Shih-heng Chen

⁴Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
Hung-chi Chen

²Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan, ROC

Abstract

Background Lower extremity salvage following significant soft tissue loss can be complicated by lack of recipient vessel for free tissue transfer. We describe our experience in lower limb salvage for patients with no recipient vessels with the use of pedicle, free and cable bridge flaps.

Methods A retrospective review from 1985 to 2017 of patients undergoing lower limb salvage using a contralateral pedicle cross leg (PCL) flaps, free cross leg (FCL) flaps, or free cable bridge (FCB) flaps was conducted. Demographics, etiology of the reconstruction, type of flap used, donor-site vessels, defect size, operating time, time of pedicle division, length of hospital stay, time to ambulation, and complications were analyzed.

Results A total of 53 patients (48 males and 5 females) with an average age of 35 years (range, 29–38 years) were identified. The etiology for the reconstruction was trauma in 52 patients and oncological resection in 1 patient. There were 18 PCL, 25 FCL, and 10 FCB completed. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operating room times for PCL, FCL, and FCB flaps were 4, 9, and 10 hours, respectively. The average length of hospital stay was 5 weeks and average time to ambulation was 4 weeks. The average follow-up time was 7.5 years (range, 3–12 years). Complications encountered were hematoma (six), prolonged pain (six), total flap loss (two), reoperation (five), and infection (four). Limb salvage rates were 96.2%.

Conclusion When ipsilateral limb vessels are not available, and other reconstructive options have been exhausted, cross leg flaps can be a viable option for limb salvage in the setting of extensive defects.

Keywords

lower limb salvage - cross leg flap - cross leg free flap - cable bridge flap

Full Text

References

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