Our Experience with Cross-Leg Flap in Lower Extremity Damage in Pediatric Trauma

Background: Open fracture significantly increases the risk of osteomyelitis and ultimately limb loss depending upon the severity of the associated soft tissue injury. Lower extremity defects can be managed by direct closure, skin grafting, local flaps, cross-leg flap and free flap. We report on our experience with cross-leg flap in lower extremity in pediatric trauma.

Materials and Methods: six patients (five male ,one female) with a mean age of 17.3 years (range 7- 31 years) with grade III Gustilo fractures except for one patient with severe crush soft tissue damage in the dorsum of his foot, were included in the study. Cross-leg flap with transfixation by external fixator between the two legs was performed. Three weeks later on, it was removed and skin grafting of the donor side was done.

Results: 4 flaps were completely available; one case had marginal necrosis which was removed during the second stage of surgery and was treated conservatively later on. All flaps served the reconstructive purposes, and none of them required a major secondary procedure, but two patient`s required secondary orthopedic procedures such as bone grafting or Ilizarov for fracture healing and bone transportation. No complications were noted related to the donor site, flap, or to the immobilization method. Each patient resumed essentially normal gait and activity without any stiffness of joints.

Conclusion: The cross-leg flap is a safe and reliable alternative to free tissue transfer in certain situations of nonreconstructable lower-limb trauma. This flap is easy to perform and does not require the sophisticated equipment and expertise of microanastomosis. By incorporating the use of external fixation which aids greatly in wound care as well as for general ease of patient mobility and positioning, the versatility of the flap can be enhanced.