Newer applications of the cross-leg flap

Five recent examples of the cross-leg flap are presented. Its applications and design have been altered and its versatility widened by using muscle. In all cases the use of a Hoffmann apparatus facilitated not only fixation of the flap but also patient comfort, since ropes attached to side-arm rods can be put over pulleys and weights attached to take the strain off potential pressure points. The technetium scan was helpful in determining when flap division should be done. Flaps were rarely in place more than three weeks before division: often, especially in children, division is possible by two weeks. By clamping the flap with a soft clamp and giving an intravenous bolus of fluorescein, circulation can be ascertained unequivocally. Cross-leg flaps remain a useful and highly reliable tool for the reconstruction of difficult wounds of the lower limb.