The Cross-Leg Gastrocnemius Muscle Flap for Leg Reconstruction of the Difficult and Unfavorable Conditions

비복근을 이용한 교차하지 근육 피판술

  • Kim, Ji Ye (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju Christian Hospital) ;
  • Yang, Eun Jung (Samsung Medical Center, Department of Plastic and Reconstructive Surgery, Sungkyunkwan University, School of Medicine) ;
  • Hwang, Eun A (Department of Plastic and Reconstructive Surgery, Konkuk University, School of Medicine, Chungju Hospital) ;
  • Kim, Sug Won (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine, Wonju Christian Hospital)
  • 김지예 (연세대학교 원주의과대학 성형외과학교실) ;
  • 양은정 (성균관대학교 의과대학 삼성서울병원 성형외과학교실) ;
  • 황은아 (건국대학교 의학전문대학원 성형외과학교실) ;
  • 김석원 (연세대학교 원주의과대학 성형외과학교실)
  • Published : 2009.09.15

Abstract

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

Keywords

References

  1. Reddy V, Stevenson TR: MOC_PS(SM)cmE article: lower extremity reconstruction. Plast Reconstr Surg 121: 1, 2008
  2. Taylor GI, Townsend P, Corlett R: Superiority of the deep circumflex iliac vessels as the supply for free groin flap. Plast Reconstr Surg 64: 745, 1979 https://doi.org/10.1097/00006534-197912000-00001
  3. Hollier L, Sharma S, Babigumira E, Klebuc M: Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg 110: 1673, 2002 https://doi.org/10.1097/00006534-200212000-00008
  4. Lee HK, Lee JH, Park C, Tark KC: Lower leg resurfacing by "Cross-leg fashioned" various free flaps. Korean J Plast Reconstr Surg 22: 1237, 1995
  5. Gozu A, Ozyigit T, Ozsoy Z: Use of distally pedicled sural fasciocutaneous cross-leg flap in severe foot and ankle trauma: a safe alternative to microsurgery in very young child. Ann Plast Surg 55: 374, 2005 https://doi.org/10.1097/01.sap.0000178808.08206.7f
  6. Lee JB, Lee SJ, Kim IG, Kim SW: Cross-leg Achilles tendon reconstruction using a composite flap of dorsalis pedis and tendon strips of the extensor digitorum longus in a vascular compromised wound. J Korea Soc Plast Reconstr Surg 32: 539, 2005
  7. Chen HC, Mosely LH, Tang YB, Wei FC, Noordhoff MS: Difficult reconstruction of an extensive injury in the lower extremity with a large cross-leg microvascular composite- tissue flap containing fibula. Plast Reconstr Surg 83: 723, 1989 https://doi.org/10.1097/00006534-198904000-00022
  8. Kesiktas E, Yavuz M, Gencel E, Dalay C, Acarturk S: Use of cross-leg latissimus dorsi free flap for repair of extensive lower leg electrical injury in a child. Burns 32: 507, 2006 https://doi.org/10.1016/j.burns.2005.10.018
  9. Yamada A, Harii K, Ueda K, Asato H, Tanaka H: Versatility of a cross-leg free rectus abdominis flap for leg reconstruction under difficult and unfavorable conditions. Plast Reconstr Surg 95: 1253, 1995 https://doi.org/10.1097/00006534-199506000-00017
  10. Serel S, Kaya B, Demiralp O, Can Z: Cross-leg free anterolateral thigh perforator flap: a case report. Microsurgery 26: 190, 2006 https://doi.org/10.1002/micr.20224
  11. de Roche R, Vogelin E, Regazzoni P, Lijscher NJ: How does a pure muscle cross-leg flap survive? An unusual salvage procedure reviewed. Plast Reconstr Surg 96: 540, 1994
  12. Ladas C, Nicholson R, Ching V: The cross-leg soleus muscle flap. Ann Plast Surg 45: 612, 2000 https://doi.org/10.1097/00000637-200045060-00007