Manisa Celal Bayar University, Manisa, Turkey.
Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
Int J Low Extrem Wounds. 2020 Sep;19(3):255-261. doi: 10.1177/1534734620913414. Epub 2020 Apr 19.
When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.
当受伤肢体中没有合适的血管可供显微外科移植时，可以考虑交叉腿游离皮瓣进行下肢重建。本报告描述了一些下肢创伤患者，他们接受了交叉腿游离皮瓣重建手术，术中保留了受区动脉的血流。前外侧大腿皮瓣适用于中小面积缺损。股外侧皮动脉的降支在近端和远端 2cm 处解剖，并呈 T 形准备。T 形的分支在交叉腿游离皮瓣手术的第一阶段与对侧腿的受区动脉吻合。3 周后，皮瓣动脉从分叉处分离。对于大面积缺损，选择背阔肌皮瓣。胸背动脉与对侧胫后动脉在第一阶段吻合。3 周后，为了保持受区血管的完整性，从皮瓣切断胸背动脉并与胫后动脉的远端残端吻合。2017 年 1 月至 2019 年 1 月期间，8 例缺损采用前外侧大腿皮瓣重建，其余 4 例缺损采用背阔肌皮瓣重建。所有皮瓣均存活，无并发症。通过多普勒超声确认所有受区动脉吻合口远端的前向血流。在交叉腿游离皮瓣中，可以建立受区动脉的连续性，以防止受区肢体血流减少。
