Cross-leg flap, alternative surgery for post traumatic soft tissue defect of ankle and foot

Background

Soft tissue defects that afflict the ankle and foot are mostly the result of trauma. Large wounds with soft tissue defects, especially in the ankle and foot, are a reconstructive challenge due to the lack of availability of local tissues and recipient vessels.

Case Presentation

We report a female with a crush injury of the right foot and a Lisfranc injury due to a motor vehicle accident. The patient had a soft tissue defect 20 × 10 cm2 with bone and tendon exposed. The patient had a fasciocutaneous flap from the posteromedial of the distal contralateral leg for soft tissue reconstruction. Both legs were stabilized with a cast. The cross-leg flap was separated from the donor site three weeks later, and K-Wire was removed. Flap evaluation was good, and the patient resumed normal gait and activity without any stiffness of joints related to the flap or cast.

Discussion

Reconstruction of soft tissue defects in the ankle and foot is a challenge for surgeons due to the paucity of local and regional tissues and associated vessel injuries. Cross-leg flap can be suitable alternative option. In this case, we use medially based fasciocutaneous perforator cross-leg flap, based on the posterior tibial artery perforators. Cross-leg flaps are less technically demanding, and the probability of reexploration is lower than in free flaps. The cross-leg flap has the disadvantage of prolonged immobilization and uncomfortable resting positions.

Conclusion

Cross-leg flap can be alternative solution for covering large soft tissue defects in ankle and foot with its advantages and disadvantages.