The cross-leg soleus muscle flap

Reconstruction of the lower limb can be a difficult problem, especially when located over the lower third of the leg, or when a large soft-tissue defect exists. When local flap coverage is not possible, a distant flap--free or pedicled--is indicated. There are, however, circumstances that preclude the use of a free flap, and in these situations cross-leg flaps remain a viable alternative. They have been proved to be safe, are usually quick to perform, and do not require specialized facilities for postoperative monitoring. A new variation of the soleus muscle flap--the cross-leg soleus muscle flap--is described. Using this modification, the authors successfully closed large defects of the lower limb in 9 patients. The donor site defect that is left on the contralateral limb is far more acceptable than that left by conventional cross-leg fasciocutaneous or musculocutaneous flaps. The authors prefer the cross-leg soleus flap to conventional cross-leg flaps in these situations.