ABSTRACT
The authors present a procedure that can be used in cases of massive skin and soft
tissue defect accompanied by extensive vascular injury. The technique involves the
use of two donor components (a free skin flap and a vascular donor) which form a single
unit postoperatively. The free flap is stretched over crossed limbs, with its major
lateral portion serving to cover the defect, and the margin of its medial portion
containing the flap pedicle sutured to a pedicled skin flap from the healthy contralateral
limb. End-to-end anastomoses of vessels from both components are performed within
the skin bridge that connects the crossed limbs. A temporary cross-over vascular supply
to the free flap from vessels of the healthy limb is thus created. The procedure is
offered as a satisfactory solution to the problem of transferring free flaps in cases
where recipient site vessels are absent or unusable.
