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Perforator-Based Pedicled Cross-Leg Flaps in Pediatric Patients: A New Idea to Increase Flap Reach
Ahmed Gaber Abdelmegeed1, Tarek Abdelhameed Abulezz, Mohamed Abdel-Al Abo-Saeda
1From the Plastic Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
Insights
This study introduces a modification to cross-leg flaps for pediatric lower limb reconstruction, enhancing flap reach and inset ease. The technique proved successful in 50 pediatric patients, improving reconstructive outcomes.
Area of Science:
- Plastic Surgery
- Microsurgery
- Pediatric Surgery
Background:
- Distal lower limb reconstruction presents significant challenges in plastic surgery.
- Pedicled cross-leg flaps remain crucial, especially for pediatric patients, despite advances in microsurgery.
- Fasciocutaneous flaps and understanding the perforator system have improved lower leg reconstruction.
Purpose of the Study:
- To present a novel modification for cross-leg flaps to increase their reach and simplify inset.
- To evaluate the efficacy and safety of this modified technique in pediatric lower limb reconstruction.
Main Methods:
- A fasciocutaneous flap is designed from the posteromedial leg, based on at least two perforators identified by Doppler.
- Two back cuts are made at the flap base edges, preserving the identified perforators to enhance reach.
- The flap is elevated and inset to reconstruct distal lower limb defects.
Main Results:
- Fifty pediatric patients (32 male, 18 female) aged 4-13 years underwent reconstruction.
- Defect sizes ranged from 20 to 130 cm².
- All flaps survived; minor complications included marginal ischemia (3), infection (2), and partial dehiscence (1).
Conclusions:
- Preserving perforators with back cuts at the base of cross-leg flaps increases flap reach without compromising viability.
- This technique is simple, requires no additional equipment, and is time-efficient.
- The modification facilitates easier inset and improves outcomes in lower limb reconstruction.
Background:
Distal lower limb reconstruction is one of the most difficult and challenging tasks in plastic surgery. Despite the continuous advances in microsurgical techniques, pedicled cross-leg flaps still have a major role particularly in pediatric patients. Many techniques have been described to maximize the potential of the cross-leg flaps. The introduction of fasciocutaneous flaps has provided more potentials and made lower leg reconstruction easier and more successful. The description of perforator system in the leg has also made a revolution in the regional reconstruction. In this report, we present a new modification that increases the reach and facilitates the inset of the flaps.
Methods:
The flap is taken from the posteromedial skin of the middle third of the leg. The design is determined by the location, size, and shape of the defect. The base of the flap should contain at least 2 perforators located by Doppler device. After elevation of the fasciocutaneous flap, 2 back cuts are performed in the upper and lower edge of the flap base preserving the 2 previously located perforators.
Results:
Fifty patients, 32 males and 18 females, were reviewed and presented. Age of the patients ranged from 4 to 13 years and the defect size ranged from 20 to 130 cm. All flaps survived with 3 flaps had mild marginal ischemia, 2 flaps had mild infection, and 1 flap had partial dehiscence.
Conclusions:
Back cuts made at the edges of the base of a cross-leg flap, preserving the feeding perforators, can increase the flap reach without jeopardizing its viability. It is also an easy to do technique and does not require any extra equipment or time.
