Dynamic axial fixation for immobilization of cross-leg flaps in chronic osteomyelitis

Free flaps are usually the first choice for soft tissue coverage in the distal leg. There continue to be, however, some clinical situations in which a cross-leg flap is the best choice. Use of the cross-leg flap has previously been limited by the difficulty of immobilizing both legs during the early healing stage (2 to 3 weeks). The traditional plaster immobilization or multibar external fixator system is time consuming to apply, difficult to adjust, cumbersome for nursing care, and uncomfortable for the patient. We have used the Orthofix external fixator to immobilize a cross-leg flap in 3 patients with refractory distal tibial osteomyelitis. The Orthofix dynamic axial fixator (DAF) is a single frame external fixator which, when used in a cross-leg fashion, is quick and easy to apply. It provides the necessary strength for immobilization and overhead suspension. It has few parts and is therefore lighter and less awkward both for the patient and nursing personnel and is easy to adjust on the ward or in the clinic. The DAF has two modes: locked (static) and released (dynamic). The locked mode can be easily adjusted to alter tension on the healing flap. As the flap matures the dynamic mode allows the frame to slide, decreasing muscle spasms and increasing flap movement. The DAF also provides better soft tissue access for flap observation and nursing care. Few transfixation pins are needed, decreasing the chance of pin tract infection. When a cross-leg flap is required, use of the DAF for immobilization circumvents many of the previous problems with both-leg immobilization.