Abstract
Soft-tissue coverage after complex distal lower extremity trauma is often difficult
due to limited local flap options and injury to potential recipient vessels when considering
microsurgical reconstruction. Therefore, obtaining recipient vessels outside the zone
of injury to optimize successful free tissue transfers remains a basic tenet of microsurgery.
We present a case of a crush injury to the lower extremity with open tibia and fibula
fractures and a large soft-tissue defect that required reconstruction for limb salvage.
Due to recipient vessel thrombosis within the affected extremity even well proximal
to the zone of injury, contralateral lower extremity recipient vessels were used as
an alternative for cross-leg flap limb salvage. We performed flap pedicle division
6 weeks after inset. Follow-up 9 months after reconstruction showed the patient achieving
independent ambulation. In conclusion, cross-leg free flaps may be used as a last
resort to successfully salvage flaps in the setting of poor ipsilateral recipient
vessels and repeatedly occluding anastomoses.
Keywords
cross-leg free flap - lower extremity reconstruction - lower extremity trauma
