Cross-leg Pedicled Free Scapular Flap for the Repair of Extensive Soft Tissue Defect with Tibial Bone Exposure.

Free scapular flaps are suitable for many lower extremity applications and often provide excellent contour reproduction and appearance. However, when the soft tissue defect of the lower leg is extensive and complicated there may not be vessels in the recipient site suitable to be anastomosed. A cross-leg pedicled free flap technique can be applied in this situation. This study extends the indications and reports a successful experience using cross-leg pedicled free scapular flap to cover an extensive soft tissue defect with tibial bone exposure of the lower leg. This study involved 24 patients between May 2000 and October 2005. Wounds were caused by accident (6 patients), burn (2 patients), electrical injury (3 patients), and fall (2 patients). The defects ranged in size from 8 cm x 15 cm to 15 cm x 30 cm. All patients were treated with free scapular flaps to cover the defects and the vessels of the free scapular flaps were anastomosed with the dorsalis pedis vessels of contralateral leg in order to provide temporary blood supply. Both legs were fixed in a cross-leg position by plaster cast. The pedicle was divided after 4 to 5 weeks and the donor site of dorsum pedis was re-sutured. Blood supply was re-established in all 13 patients. All free scapular flaps survived and the defects were covered completely. The defective lower extremities regained function with no deformities in donor sites of the contralateral lower leg. The authors believe that use of the cross-leg pedicled free scapular flap in patients with a difficult lower extremity wound with extensive tissue defect and tibial bone exposure is a worthwhile procedure and should be attempted if possible. The scapular flap has several advantages applicable to the cross-leg pedicled free flap technique. Although the operation is divided into 2 stages, it solves the problem and can offer temporary blood supply when there is no vessel for anastomosis in the recipient site, which decreases the risk of microanastomosis and produces good results.