• Archives of Plastic Surgery
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• v.50 no.5
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• pp.507-513
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• 2023

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg. Methods This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg. Results The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm². Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia. Conclusion Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.255-261
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• 2019

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.583-590
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• 2009

Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

• 대한미세수술학회:학술대회논문집
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• 1994.11a
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• pp.110.2-111
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• 1994

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.165-174
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• 1998

Large soft tissue defect of the ankle and foot can present a difficult reconstructive problem to the surgeon. Local musculocutaneous, local fasciocutaneous or free flap is usually the first choice for providing soft tissue coverage. However, in certain situations, local flaps from the same leg and free flap may not be suitable. These include extensive soft tissue injury, where no suitable recipient vessels can be found, previous local fasciocutaneous flap or free flap failure. In such cases, we have utilized the septocutaneous(fasciocutaneous) branch flap of posterior tibial artery from the opposite healthy limb. We present 5 cases of cross leg flaps, which have been modernized with current understanding of vascular anatomy and current fixation technology. All cross leg flaps were based on the axial blood supply of the fasciocutanous branch of the posterior tibial artery. Cross-clamping with bowel clamp was used to create intermittent periods of ischemia. Adjacent lower extremity joints were exercised during the periods of attachment. The results have been quite encouraging. We conclude that the cross leg flap using septocutaneous flap and cast immobilization can be successfully and expeditiously used to cover defects of the ante and foot.

• Journal of the Korean Geosynthetics Society
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• v.17 no.1
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• pp.111-118
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• 2018

In case of excavation of the tunnel under weak ground conditions, such as fault zone, leg pile reinforcement with the purpose of suppressing tunnel crown settlement and side wall displacement is commonly applied. There are convergence, crown settlement, leg settlement, and the axial force of leg as a main factor for confirming the safety of support considering the installation angle and length of leg pile reinforcement according to the increase in rate of change of tunnel cross-section. In particular, the influence of right corner settlement, among variables for safety confirmation during excavation, has been analyzed as the dominant factor in the most important priority management showing larger displacement tendency than the increase in rate of the cross-section. And, it was analyzed that the occurrence tendency of axial force on leg pile reinforcement showed the influence of behavior according to the friction support concept mechanism of the pile reinforcement rather than the increase in rate of tunnel cross-section, as it showed a small increase compared to the increase rate of the tunnel cross-section which did not show a great correlation from the viewpoint of the change of the axial force by the length of each leg pile reinforcement with regards to the change in rate of increase in tunnel cross-section. If a certain length of the leg pile reinforcement is selected based on the above grounds, even if the cross-section of the tunnel in poor ground condition is somewhat larger, it has been proved to be a more reasonable method considering the workability and economical efficiency by not extending the length of the leg pile reinforcement by force.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.591-596
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• 2009

Purpose: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra - lateral vessel can be a solution. Methods: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(male = 9, female = 3). External fixators used in all cases. Free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. Results: All flaps survived without additional operative procedures. There were no complications such as hematoma or Infection. Sometimes patients needs further therapeutic exercise for fast movement recovery. Conclusion: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.

• The Journal of Korean Physical Therapy
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• v.27 no.6
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• pp.430-433
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• 2015

Purpose: The purpose of this study was to investigate the effects of a four week unilateral isokinetic exercise program applied to ankle on the one-leg stance balance performance of ipsilateral and contralateral lower-limbs. Methods: Subjects were randomly assigned to either a right ankle training program (n=12) or a control group (n=12). The training group received unilateral ankle isokinetic exercise of the dominant side for 4 weeks, whereas control group did not. Ipsilateral and contralateral one-leg balance were measured before and after intervention using the Biodex Balance System. Results: Improvements of stability scores, such as APSI, MLSI, and OSI, from pre-test to post-test were significantly different greater for the training group when the control. Conclusion: The results of this study suggest unilateral ankle strengthening exercise transfers benefit to the untrained limb by a cross-education effect, and that this type of exercise should be considered to improve one-leg standing balance of trained and untrained lower-limbs.

• Physical Therapy Korea
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• v.15 no.4
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• pp.80-86
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• 2008

Cross-legged sitting postures are commonly assumed during computer work. The purpose of this study was to determine the effects of leg crossing on trunk muscle activity while typing at a computer. Trunk muscle activity was measured in three 8 different sitting postures, in random order. These posture were: normal sitting with a straight trunk and both feet on the floor (NS), upper leg crossing (ULC), and ankle on knee (AOK). The right leg was crossed onto the left leg in both cross-legged postures. Twenty able-bodied male volunteers participated in this study. Subjects typed on a computer keyboard for one minute. Surface electromyography (EMG) was used to record bilateral muscle activity in the external oblique (EO). internal oblique (IO), and rectus abdominis (RA). The EMG activity of each muscle in the NS posture was used as a reference (100% EMG activity) in relation to the two cross-legged postures. Muscle activity in the right EO. right IO, and left IO was significantly lower in the ULC posture than in the NS posture. In contrast, muscle activity in the right RA was significantly higher in the ULC posture than in the NS posture. Muscle activity in the tight RA was significantly higher in the AOK posture, as compared to the NS posture, whereas activity in the left IO was significantly lower in the AOK posture, as compared to the NS posture. The right-left muscle activity ratios in the EO and IO showed significantly different patterns in the cross-legged postures, suggesting that asymmetrical right-left oblique muscle activity had occurred.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.74-81
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• 2004

This study was designed to introduce the cross-leg free flap only for vein anastomosis as an alternative salvage method for the reconstruction of severe soft tissue defects in vascular-compromised lower extremities. Four cross-leg free flap reconstructions were performed using the latissimus dorsi muscle to reconstruct soft tissue defects in the lower extremity. The recipient artery was confined to the ipsilateral side and the venous anastomosis was carried out in the contralateral side. Both legs were immobilized together with an external fixator. All patients were males, and had a mean age of 31 years. The mean time of pedicle division was 8.8 days range of 7 to 10 days. The mean size of the flap was 186.5 cm2. All flaps survived after pedicle division without venous congestion. There was no complication in joint stiffness, nor donor site morbidity except for a linear scar. The cross-leg free flap only for vein anastomosis is a refinement of a salvage procedure used for the reconstruction of severe soft tissue defects in vascular-compromised lower extremities.