Mishra Amit Kumar, Thapa Anup, Sharma Samit
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of Plastic Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Int J Surg Case Rep. 2025 Feb;127:110892. doi: 10.1016/j.ijscr.2025.110892. Epub 2025 Jan 15.
Soft tissue defect in the lower limb presents as a difficult reconstructive challenge. Cross-leg flap was routinely used in the past for the salvage of the lower limb but is seldom used nowadays due to advances in microsurgical procedures.
We present a case of an 18-year-old male who presented with a complex soft tissue defect of 25 × 10 cm on the anterolateral aspect of the right leg following a motor vehicle accident. The defect was unsuitable for local flaps due to the unavailability of healthy tissue or free tissue transfer as no suitable recipient vessels were available for microvascular anastomosis in the vicinity. After serial debridement, the patient was planned for a distal cross-leg fasciocutaneous sural artery flap from the left leg to cover the defect. The cross-leg flap was elevated over the posterior aspect of the left leg with 2 delay procedures over 2 weeks and inset was done over the defect with an intact pedicle. External fixators were applied to fix the legs in a cross-leg position. Finally, the flap was detached after 3 weeks.
Cross-leg flap has a clear role in reconstructive trauma surgery because of its simplicity, good-quality coverage, and minimal cosmetic disadvantage. We, therefore, advise its application in cases when microvascular competence or operating room time is limited, or the injury is not suitable for local tissue transfer.
A pedicled cross-extremity flap can be successfully employed for the salvage of the limb in a resource-limited setting.
下肢软组织缺损是一项具有挑战性的重建难题。过去，交叉腿皮瓣常用于挽救下肢，但由于显微外科手术的进展，如今已很少使用。
我们报告一例18岁男性患者，在机动车事故后，右腿前外侧出现25×10 cm的复杂软组织缺损。由于缺乏健康组织，且附近没有适合进行微血管吻合的受区血管，无法进行局部皮瓣或游离组织移植，该缺损不适合采用上述方法修复。经过多次清创后，计划采用来自左腿的远端交叉腿腓肠神经营养血管筋膜皮瓣覆盖缺损。在左腿后侧掀起交叉腿皮瓣，分2期延迟2周进行，带完整蒂部将皮瓣移植到缺损处。应用外固定器将双腿固定于交叉腿位。最后，3周后断蒂。
交叉腿皮瓣在创伤重建手术中具有明确的作用，因其操作简单、覆盖效果良好且美容缺陷最小。因此，我们建议在微血管吻合能力或手术室时间有限，或损伤不适合局部组织转移的情况下应用该皮瓣。
在资源有限的情况下，带蒂交叉肢体皮瓣可成功用于挽救肢体。
