The injured foot: cutaneous coverage with a distally based posterior tibial cross leg flap

Treatment of extensive soft tissue defects of the foot has long been a challenging problem for the reconstructive surgeon. We report a series of 5 injured feet with major soft tissue loss and significant bony injury, treated with distally based cross leg flaps based on the posterior tibial artery, with satisfactory cosmetic and functional results. The survival of the flap was complete in 4 of the 5 patients; in one case, the flap suffered about 2-3 cm distal partial necrosis. The mean hospital stay was 30 days, and walking without ambulatory support was possible about 60 days postoperatively. We consider this procedure a potential alternative to microvascular techniques for the treatment of severe foot injuries, in an area where microsurgery reconstruction is fraught with difficulties.