Cross-leg Axial Flap For Repairing Soft-tissue Defect In Lower Leg And Foot

Objective: To summarize clinical experience of eight types of cross-leg axial flap for repair of soft-tissue defect in lower leg and foot, Explore the advantage,disadvantage and clinical indications of five types of cross-leg pedicled flap and three types of cross-leg free flap.Method: To retrospect and analyse the information about the clinical application of axial cross-leg flap in 40 patients from Auguest 2000 to April 2009. Five types of pedicled cross-leg axial flap were used in 21 cases, including 11 reversed island cross-leg flaps pedicled with the posterior tibial artery,the size of flaps ranged from 13.0cm×5.0cm to 24.5cm×13.0cm; 7 fasciocutaneous cros-leg flaps pedicled with the septocutaneous perforators of the posterior tibial artery, The dimension of flaps ranged from 5.0cm×4.0cm to 14.0cm×10.0cm; 2 medial gastrocnemius myocutaneous cross-leg flaps, 2 cross-leg flaps based on Saphenous artery, 1 cross-leg sural neurovascular flap. The defects located at cnemis in 12 cases, anterior pedis and plantar in 5cases, heel in 3 cases, dorsum of foot in 1cases. Construction of the Skin Bridge: the skin bridge was encased by skin tube in 2 cases of reversed island cross-leg flaps pedicled with the posterior tibial artery, the fasciocutaneous side of skin bridge was performed dermatoplasty with epidermal skin graft in 19 cases. Both lower extremity are fixed in parallel position in 8 cases, non-parallel position in 13 cases, three types of axial cross-leg free flap were used in 10 cases, including cross-leg free flaps supplied by the deep inferior epigastric vessels in 8 cases (in one patient latissimus dorsi free flap and free flaps supplied by the deep inferior epigastric vessels were transplanted paralleled) ,cross-leg latissimus dorsi free flap in two cases, cross-leg free anterolateral thigh flap in one case. The defects located at superior-middle segments of the cnemis in 2 cases, most anterior cnemis in 3 cases, distal third leg, foot and ankle in 5 cases. The size of flaps ranged from 18.Ocmx6.5cm to 32.0cm×13.0cm.Both lower extremity are fixed in parallel position in 10 cases. The statistics was used to compare reversed island cross-leg flaps pedicled with the posterior tibial artery and fasciocutaneous cross-leg flaps pedicled with the septocutaneous perforators of the posterior tibial artery, cross-leg free flap and cross-leg pedicled flap,reversed island cross-leg flaps pedicled with the posterior tibial artery respectively. Statistics analytical method: t-test and chi-square test are used for mono-factor analysis.Result: Twenty of the 21 pedicled cross-leg axial flap survived uneventfully, and one medial gastrocnemius myocutaneous cross-leg flap underwent partial necrosis after skin bridge amputated, then the wounds were annihilated by secondary suture, The survial ratio of the flaps was 95% . Eight of the 10 flaps in cross-leg free flaps survived completely, 1 flap underwent partial necrosis, then the wounds were annihilated by secondary suture; one flap underwent uneventful necrosis, the wound healed through cross-leg median gastrocnemius myocutaneous flap. Through 2 weeks to 42 months follow up, the 31 flaps survived well, and there were no relapse of suppuration. The average length of flap plus skin bridge(23.1±4.7cm),average dimension of flap(174.7±83.3cm~2) of reversed island cross-leg flaps pedicled with the posterior tibial artery are respectively more than average length of flap plus skin bridge(17.3±4.2cm),average dimension of flap(87.0±36.6cm~2) of fasciocutaneous cross-leg flaps pedicled with the septocutaneous perforators of the posterior tibial artery (P<0.05) .The average length of flap(23.3±5.4cm),average width of flap(10.4±2.6cm),average dimension of flap(249.5±92.2cm~2) of cross-leg free flap are respectively more than average length of flap(14.7±5.0cm),average width of flap(8.0±2.6cm),average dimension of flap(125.4±77.7cm~2) of pedicled cross-leg flap ( P < 0.05 ) . The average length of flap(23.3±5.4cm)of cross-leg free flap was more than average length of flap(18.0±3.9cm)of reversed island cross-leg flaps pedicled with the posterior tibial artery (P<0.05) .Conclusion:①The procedure is simple and effective, which fasciocutaneous side of skin bridge in pedicled cross-leg axial flap was performed dermatoplasty with epidermal skin graft, causes a relatively small injury to the Contralateral limb and the skin bridge whiah is soft and relatively thin can not be compressed.②The reversed island cross-leg flaps pedicled with the posterior tibial artery which has the advantages of flexible pivot point,reliable survival and the large cutting territory and survival area are applicable to repair the medium and large-sized soft tissue defects in lower leg and foot.③The cros-leg fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery which canot injure the posterior tibial vessels in Contralateral limb and survive reliably are applicable to repair the Small and medium-sized soft tissue defects in lower leg and foot.④The cross-leg free flap are applicable to repair the large-sized soft tissue defects in lower leg and foot and easy to fixed the lower extremity in parallel position.