Modification of External Fixator in Cross-Leg Flap: A Stabilizing Solution for an Optimal Outcome

Lower limb defects with single-vessel supply and with monophasic flow are difficult to reconstruct due to paucity of coverage options. The cross-leg flap remains a reliable salvage option in these settings. But maintaining the position for three weeks is cumbersome for both the patient and the flap. Any movement of the lower limb generates a shearing force at the flap inset, predisposing to partial flap necrosis and dehiscence. An external fixator helps both the stable fixation of the lower limbs and the prevention of stretch in the flap. We aim to describe a modification in the conventional external fixator to prevent maceration of the lower limbs and the flap, and also facilitate ease of dressing.

We assessed eight patients retrospectively who underwent cross-leg flap for post-traumatic leg defects, where an external fixator was applied for better flap stabilisation.

All patients were male with post-traumatic soft tissue defects in various regions of the leg and foot, with variable underlying vital structures exposed. The average age of the patients was 41 years, with a range of 16-55 years. An external fixator was applied in all cases, with a modification of an additional tubular rod used at the base to prevent the legs from contacting the bed, thus preventing maceration and difficulty in dressing. All flaps survived well, but with partial necrosis of the distal margin in two patients, which was managed with debridement and advancement of the flap. The donor site was skin grafted.

External fixator is a reliable option for stabilising lower limbs in cases of cross-leg flap reconstruction. With the modification, it not only stabilises the lower limbs but also helps in preventing maceration and increasing airflow.