Sp free flap with wound vac and xenograft postop dx. However, with the advent of microvascular surgery and the introduction of the free flap in 1970, use of the cross leg flap and other distant flaps declined. Crossflap definition of crossflap by medical dictionary. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. The crossleg flap became widely popular during world war ii as a limb salvage technique to treat injuries sustained in battle. From 1996 to 2003 there were 15 patients who had reconstruction of the hand and upper extremity using the altf. The postoperative infection rate was the highest in the. After debridement medial gastrocnemius flap was applied. Crossleg flapsharing technique using an anterolateral thigh perforator flap. The cross leg fasciocutaneous flaps are less frequently indicated for distal leg and foot. The cross leg flap became widely popular during world war ii as a limb salvage technique to treat injuries sustained in battle. Surgeons have long sought an alternative to the crossleg flap. Pdf free and pedicle flaps in lower extremity trauma. The limbs were immobilized both proximally and distally.
Is having a inner thigh flap for breast reconstruction. Senior surgical registrar, birmingham regional plastic unit and united birmingham hospitals the purpose of this paper is to introduce a mechanical fixation apparatus employed in the operation of crossleg flap, and to describe the modifications of operative technique which have arisen from its use. These perforating vessels are typically numbered 14 in a superior to inferior direction. Jan 01, 2010 briefly, the anterolateral thigh flap is a relatively new free tissue transfer and has been described for soft tissue coverage in other than the foot and ankle. Reconstruction of the lower extremity using free flaps.
However, the crossleg flap remains an effective alternative in situations that require an alternative to free tissue transfer. The traditional cross leg reconstruction used a random patterned flap with a wide base, making the flap vulnerable to ischemia and venous insufficiency. Anterolateral thigh free flap for reconstruction of a. Various donor sites have been recommended in the literature. Instead of doing a worksheet and throwing it away, students will create their own book of multiples and have. Cross leg free flaps have been used to reconstruct defects that would otherwise lead to amputation in patients with no ipsilateral recipient vessels. Its hard to conceptualize what these flap books or lap books look like without examples, so feel free to flip through the handson examples we have during the. Four days following free flap reconstruction of his right leg, the patient was discharged to the plastic surgery ward where he continued to improve with no complications regarding his free flap reconstruction and 95% take of the skin graft covering the flap. Sep 03, 2019 lateral thigh flap the lateral thigh free flap is a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin. The options discussed were to perform a pedicled flap, to perform a second free flap or to recycle tissues. The flap allows for a large amount of tissue, thus coverage of a large defect. Lifttheflap shadow book christmas lifttheflap shadow.
Therefore, before and after photos appearing on our web site have been used with the written consent of our patients. Crossleg free muscle flaps for reconstruction of open. Revisiting the fasciocutaneous perforator crossleg flap ncbi. Pdf free anterolateral thigh flaps for upper extremity. Use of the anterolateral thigh free flap for upper. Lifttheflap shadow book christmas lift theflap shadow books priddy, roger on. Free flap reconstruction following lower leg trauma in the. Free implies that the tissue is completely detached from its blood supply at the original location donor site and then transferred to another. Aug 01, 2008 table 1 demographics of three distinct cases describing the modified cross leg flap for large triangular defects of the foot and ankle. Venous compromise revised with wound exploration and. Reconstruction of the lower extremity with crossleg free. Terminology flap base proximal part when the whole flap inset into defect flap pedicle proximal part when the only distal part of flap inset into defe ct flap bridge central part when the only distal part of flap inset into defec t penninsular flap flap passes in whole into defect island flap pedicle is deepithelialized and tunneled to reach defect.
Leg flap the privacy of our patients is extremely important to us. With the help of this intuitive application you can easily import excel spreadsheet data to your mysql databases, in. The selection criteria were injuries with exposed ten don, bone, or neurovascular structures. The crossfinger flap an established reconstructive procedure david a. All three defects were covered with a medially based narrow pedicled triangular cross leg flap based on 23 adjacent posterior tibial perforators about 12 cm from the medial border of the tibia in its middle.
The records of all patients who had cross leg flap for trauma in the last 2. It does not make sense to add a 2nd tissue flap in a 2nd stage procedure. Enter your mobile number or email address below and well send you a link to download the free kindle app. Senior surgical registrar, birmingham regional plastic unit and united birmingham hospitals the purpose of this paper is to introduce a mechanical fixation apparatus employed in the operation of cross leg flap, and to describe the modifications of operative technique which have arisen from its use. The patient had a basal cell carcinoma removed from the left cheek using the mohs technique. Lifttheflap shadow book christmas lift theflap shadow books. Since its introduction in the literature 30 years ago,v the crossfinger flap has in the experience of many authors sep, 20 the smallest free flap was 5 cm. The crossleg flap technique is a wellestablished method to cover soft. Pdf free anterolateral thigh flaps for upper extremity soft.
Reconstruction of the lower extremity with crossleg free flaps. Get your kindle here, or download a free kindle reading app. Microvascular freeflap techniques to reconstruct defects of the palate and maxilla allow immediate, 1stage reconstruction. The use of external fixator for immobilization circumvents many of these problems and facilitates the use of cross leg flaps in patients in whom free tissue transfer may not be optimal. Leg flap uf health plastic surgery and aesthetics center. The largest one was the flap for which the thoracodorsal artery served as a pedicle and both the latissimus dorsi muscle 15 cm. Penninsular flap flap passes in whole into defect island flap pedicle is deepithelialized and tunneled to reach defect delayed flaps delaying of the flap by incising outline but not elevating the f lap expanded flaps delaying of the flap by tissue expanders inserted under the flap prefabricated flaps formation of a composite flap prior to. The traditional crossleg reconstruction used a random patterned flap with a wide base, making the flap vulnerable to ischemia and venous insufficiency.
However, with the advent of microvascular surgery and the introduction of the free flap in 1970, use of the crossleg flap and other distant flaps declined. Relief from all the below aspects can be experienced slowly or immediately after the periodontal flap or laser surgery. Abundant bone and soft tissues can be transferred without the limitations of vascular pedicle length and tissue orientation. During necrectomy destroyed periost and partial necrosis of the patella were observed. Partial lesion of the free skin graft was observed. However, there are certain difficult situations where the free flap cannot be employed and alternative methods. Crossleg as salvage procedure after free flaps transfer. Buchan ac 1978 the place of the cross leg flap in reconstructive surgery of the lower leg and foot. Mar 05, 2016 free flap anterolateral thigh flap to lower leg reconstruction. An alternative method to free flap for distal leg and foot defects due to electrical burn injury. When a free flap is contraindicated or after a free flap failure, the cross leg flap is still nowadays a possible. Use of the anterolateral thigh free flap for upperextremity. Nevertheless, the left patellar tendon was still exposed and needed to be covered with a flap fig.
The flaps are planned and then a number 15 blade is used to make an incision through the skin followed by undermining of the flaps with westcott scissors. A free fasciocutaneous skin flap based on one of these perforators the posterior tibial perforator flap, ptp flap. Limb salvage in an irradiated patient with limited recipient vessels leaves few options for reconstruction. Lateral thigh and anterolateral thigh free tissue transfer. Its reliability and outcome late after injury in the period from april 2009 to june 2011. Anterolateral thigh free flap for reconstruction of a severe.
One flap failed in the early group, 3 in the delayed group. Good local tissue coverage was not available and free tissue transfer. The details of each case are summarized in table 1. Original article distal perforator based cross leg flaps for. Flap books are what my son calls lap books and other ways of presenting his work in a book with flaps.
Pdf crossleg flapsharing technique using an anterolateral. Dec 31, 2016 however, the cross leg flap remains an effective alternative in situations that require an alternative to free tissue transfer. Fibula flap harvest the patient is placed in the supine position with a bump under the ipsilateral hip to lessen the need for excessive internal rotation of the lower leg. Free download specifications 100% clean report malware.
I do not think i would recommend this flap on top of your existing abdominal flap. The clinical application of cross leg flaps for coverage of bone exposure on the leg. The parameters used to assess the outcome of our series included the success rate of the flap as measured by flap survival rate and adequacy of skin coverage, ability to close the donor site primarily or necessity of a skin graft, complications associated with the flap. The use of free flaps in the treatment of severe lower leg. An alternative method to free flap for distal leg and foot. Registered users can save articles, searches, and manage email alerts. The operative technique used was the standard approach so elegantly. All the patients received 1st aid resuscitative measures to minimize bleeding restore airway and correct shock. The anterolateral thigh free flap altf first was reported in 1984.
However, the situation occasionally arises in which an alternative method may be. When you visit our office for your consultation, you will be able to view a full album of before and after photos that further demonstrate our skilled work. Microvascular free flap techniques to reconstruct defects of the palate and maxilla allow immediate, 1stage reconstruction. Neurosurgery practice questions and answers 2nd edition. Crossleg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using cross leg flaps. Alternatively, the lateral decubitus position can be used, with the harvest leg placed up and the patient held in position with a beanbag. Table 1 demographics of three distinct cases describing the modified cross leg flap for large triangular defects of the foot and ankle. Is having a inner thigh flap for breast reconstruction good idea.
Before insetting the flap, the donor area and the under surface of the bridge segment of the flap were covered with split thickness skin grafts. Original article distal perforator based cross leg flaps. The majority of the patients had severe tibial fractures with extensive soft tissue loss and severe contamination. Lateral thigh flap the lateral thigh free flap is a fascial or fasciocutaneous flap based on the smaller vessels that extend from the profunda femoris system to the skin. Gum bleeding numbness or feeling of sensitivity gumnerve swelling bruising due to treatment sutures as per procedure surgical dressings needs to. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. Briefly, the anterolateral thigh flap is a relatively new free tissue transfer and has been described for soft tissue coverage in other than the foot and ankle. Flapjack educational resources teaching resources teachers.
Stark1950 standardized the procedure and summarized its usefulness for lower extremities trauma. This crossleg microvascular tissue transfer technique addresses. We present the first documented case of a cross leg free flap for limb salvage in a radiated bed after infection and tumour resection. I would either go down the fat grafting or implant route if you already have tissue flaps in each breast. An example of free flap could be a free toe transfer in which the great toe or the second toe is transferred to the hand to reconstruct a thumb. By flapjack educational resources this is a great little book for students to practice their multiples and build a foundation for learning their basic multiplication facts. Preparation of wound bed 420cm2, placement of integra 420cm2 revision of microvascular anastomosis vein placement of wound vacuum 50cm2 anesthesia.
Pedicled crossextremity flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. Even when a free tissue transfer can be performed the risk of failure remains considerable. For all free flaps, the blood supply is reconstituted using microsurgical techniques to reconnect the artery brings blood into the flap and vein allows blood to flow out of the flap. Distal perforator based cross leg flaps for leg and foot defects. A block of tissue with its own blood vessels flap is removed from the thigh and transplanted to cover wound in the lower leg. When a free flap is contraindicated or after a free flap failure, the crossleg flap is still nowadays a possible option. Elgammal ta, wei f, chen h, noordhoff ms, tang y 1997 cross leg free flaps for difficult cases of legs defects. Surgical technique the posterior tibial vessels of the contralateral leg were prepared as recipient vessels for all patients. Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Free flap anterolateral thigh flap to lower leg reconstruction.
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