CC BY 4.0 · Arch Plast Surg 2023; 50(05): 507-513
DOI: 10.1055/a-2126-7058
Extremity/Lymphedema
Original Article

Reliability and Safety of Cross-Leg Free Latissmus Dorsi Muscle Flap in Reconstruction of Mutilating Leg Injuries Using End-to-Side Anastomosis

Ahmed Gaber Abdelmegeed
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Mahmoud A. Hifny 
2   Department of Plastic Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
,
Tarek A. Abulezz 
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Samia Saied 
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Mohamed A. Ellabban 
3   Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
,
Mohamed Abdel-Al Abo-Saeda 
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Karam A. Allam
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Mostafa Mamdoh Haredy
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
,
Ahmed S. Mazeed 
1   Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt
› Author Affiliations
Funding None.
› Further Information
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Abstract

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg.

Methods This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg.

Results The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm2. Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia.

Conclusion Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

Keywords

cross-leg - end-to-side anastomoses - free latissimus dorsi flap - single-vessel leg - mutilating leg injuries

Authors' Contributions

A.G.A. and M.A.E. were responsible for conceptualization. M.M.H., M.A.H., A.S.M., A.G.A were responsible for data curation. MA A.-S. and M.M.H. were responsible for formal analysis. K.A.A. and S.S. were responsible for methodology. S.S. and A.G.A. were responsible for supervision. M.A.E. were responsible for validation. T.A.A. and A.G.A. were responsible for writing—original draft. A.S.M., M.A.H., and T.A.A. were responsible for writing—review and editing. All authors read and approved the final manuscript.


Ethical Approval

The study was approved by the Medical Research Ethical Committee of Faculty of Medicine, Sohag University (approval number: Soh-Med-22-12-42) and performed in accordance with the principles of the Declaration of Helsinki. The informed consent was waived because this study design is a retrospective review


Patient Consent

Patients have provided written informed consent for the publication and the use of their photos.




Publication History

Received: 30 December 2022

Accepted: 04 July 2023

Accepted Manuscript online:
11 July 2023

Article published online:
05 October 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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