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CC BY 4.0 · Arch Plast Surg 2023; 50(02): 188-193
DOI: 10.1055/a-1962-6009
Extremity/Lymphedema
Case Report

Cross-Leg Free Flap: Crossing the Border Zone of Ischemic Limb—A Case Report of Limb Salvage Procedure following a Delayed Diagnosis of Popliteal Artery Injury

Hui Yuan Lam 
1   Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
2   Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
,
Wan Azman Wan Sulaiman 
1   Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
2   Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
,
Wan Faisham Wan Ismail 
1   Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
3   Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
,
Ahmad Sukari Halim 
1   Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
2   Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus. Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Abstract

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

Keywords

popliteal artery - free flap - lower limb - knee dislocation

Author Contributions

Conceptualization: I.H.Y. , W.A.W.S., A.S.H., W.F.N.W.I.

Data curation: L.H.Y., W.A.W.S., A.S.H., W.F.N.W.I.

Formal analysis: L.H.Y., W.A.W.S., A.S.H., W.F.N.W.I.

Methodology: L.H.Y., W.A.W.S., A.S.H., W.F.N.W.I.

Project administration: L.H.Y., W.A.W.S., A.S.H., W.F.N.W.I.

Writing – original draft: L.H.Y.

Writing – review and editing: all authors.


Patient Consent

Written consent has been obtained from patient.




Publikationsverlauf

Eingereicht: 04. Juli 2022

Angenommen: 13. Oktober 2022

Accepted Manuscript online:
17. Oktober 2022

Artikel online veröffentlicht:
07. Februar 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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