THE CROSS-LEG FLAP REVISITED

Although free flaps are currently the gold standard for distal lower e xtremity reconstruction, situations occasionally arise where alternati ve methods are needed. We present three cases of cross-leg flaps, whic h have been modernized with current external fixation technology and c urrent understanding of vascular anatomy. All cross-leg flaps were bas ed on the axial blood supply of the posterior descending subfascial cu taneous branch of the popliteal artery. This axial flap afforded consi derable length and well-vascularized tissue. All patients were placed in external fixation devices. Adjacent lower extremity joints were exe rcised during the period of attachment. There were no major complicati ons or flap failures. All patients were ambulatory postoperatively. We conclude that the cross-leg flap, using external fixation techniques and axially based flaps, can be successfully and expeditiously used to cover defects of the lower extremities.