Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Lower limb defectsmaybe present due tovarious causes, such as infections, vascular diseases, tumor resections, and crush or avulsion injuries. If a defect in the lower extremity cannot be reconstructed with a skin graft, the choice of defect reconstruction will favor local flaps and free tissue transfers.1–5 In appropriate cases, skin graft and local flaps can be well tolerated by both patients and surgeons. However, lower limb defects need to be reconstructed using free flaps, and suitable vessels need to be present in the same extremity. In some cases, it is not possible to locate suitable vessels, particularly in cases of trauma such as crush or avulsion injuries.6 Dissection toward the proximal site of the damaged vessels may require finding a suitable zone for microvascular anastomosis. However, a vein graft or a long flap vascular pedicle may be required in such cases. Vein grafts also pose some distinctive problems, such as limited application and the risk of thrombosis and collapse.7–10 Long vascular pedicled free flaps are also generally inadequate. The cross-bridge method, described by Taylor et al in 1979, prevents recipient vessels problems. That was the first report to demonstrate that the vascular pedicle of the free flap can be anastomosed to the recipient vessels in the contralateral leg and then divided after adequate neovascularization of theflap.11 Subsequent researchers have reported