ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Distal bipedicled "supra cross leg" flap: a salvage option for complex lower limb defects.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOpen leg fractures are severe and common injuries. When a free flap and/or a local pedicled flap is not feasible or has failed, the cross-leg flap remains a last-resort option to avoid amputation. The aim of this study is to explain the technical aspects and clinical advantages of the distal bipedicled "supra cross-leg" flap, based on a series of four cases.
methodsFour patients underwent reconstruction using a distal bipedicled "supra cross-leg" flap between 2016 and 2026 at HIA Percy, a Level I trauma center and burn treatment center (Clamart, France). Demographic, trauma-related, and surgical data were collected.
resultsAll patients were male, with a mean age of 35 years (± 7.9). The distal bipedicled "supra cross-leg" flap was performed at a mean of 59 days (± 15.9) after injury. The mean flap size was 408 cm DISCUSSION: The distal bipedicled "supra cross-leg" flap is a reliable and reproducible technique that allows extensive cutaneous coverage. This flap, combining a distal sural flap and a distal great saphenous flap of the leg, enables coverage of large soft-tissue defects thanks to a wide usable flap surface and a rich, mixed vascular supply dependent on the posterior tibial and fibular vascular networks. The timing of flap division should be delayed when premature flap elevation is required for septic reasons. The length of the pedicle facilitates positioning of the flap on the recipient site. The use of external fixation to temporarily stabilize the two lower limbs provides a stable construct that facilitates nursing care and patient mobilization. LEVEL OF EVIDENCE: IV.
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