Abstract
Salvage of lower extremity following extensive loss of soft tissue and bone can be complicated by lack of recipient vessels for direct free tissue transfer. We describe our series in lower limb salvage for patients with no recipient vessels using pedicled, free and cable bridge flaps.

A retrospective study was conducted from 1985 to 2017 of patients receiving lower limb salvage using contralateral pedicled cross leg (PCL) flaps, free cross leg (FCL) flaps, or free cable bridge (FCB) flaps. Demographics, etiology of the reconstruction, type of flap used, donor-site vessels, size of the defect, operating hours, time of pedicle division, length of hospital stay, time to ambulation, and complications were analyzed.

This series included a total of 53 patients (48 males and 5 females) with an average age of 35 years (with a range of 29-38 years) . The etiology for the reconstruction was trauma in 52 patients and oncological resection in 1 patient. There were 18 PCL, 25 FCL, and 10 FCB completed. The recipient vessels for all flaps were the posterior tibial artery and vein of the contralateral leg. The average operating hours for PCL, FCL, and FCB flaps were 4, 9, and 10 hours, respectively. The average length of hospital stay was 5 weeks, and average time to ambulation was 4 weeks. The average follow-up time was 7.5 years (range, 3-12 years). Complications encountered were hematoma (6), prolonged pain (6), total flap loss (2), reoperation (5), and infection (4). Limb salvage rates were 96.2%.

When ipsilateral limb vessels are not available and there are no other reconstructive options, cross leg flaps can be a viable option for limb salvage in the situation of extensive defects.

Download