Repair of bilateral lower limb injuries using a free latissimus dorsi cross-leg flap

Current microsurgical techniques are used in single stage repair of distal lower limb defects. The previously popular cutaneous and fasciocutaneous fl aps have been practically shelved. However, in selected cases, the vessels of a lower limb can still be employed to vascularize a harvested flap for t he repair of a contralateral defect. In cases where the vessels of a trauma tized leg are severely damaged or jeopardized, vascular components of the o pposite limb can be exploited to provide the blood supply for the flap chos en to cover the defect. There are times when trauma to both legs may requir e a single large flap (latissimus dorsi) which if properly vascularized can bridge a bilateral defect. This could bring about the revival of the cross -leg flaps. Four cases are reported: in one, the flap was vascularized from a healthy limb to cover a contralateral exposed fracture and an avulsed he el. In three other cases, the latissimus dorsi was utilized to fill large p ost-traumatic bilateral defects at the distal lower limb level. In these ca ses the limb with the best vascular system was chosen for flap anastomoses and fixation was then applied.