title: Use of cross-extremity flaps stabilized with external fixation in severe pediatric foot and ankle trauma: an alternative to free tissue transfer.
abstract: Pedicled cross-extremity flaps for wound coverage have been replaced, in most cases, by free tissue transfer. Classically, cross-leg flaps have been problematic because of difficulties with immobilization and positioning of the extremities from the time of initial coverage to detachment. Three children with severe foot and ankle trauma had cross-extremity flaps using linkage of bilateral lower-extremity external fixators in place of traditional casting. Cross-leg flaps were used in two patients, and a cross-foot flap was applied in one. Each flap survived completely, and the linking fixators were disassembled at the time of flap detachment. No complications were related to the donor site or the flap itself or were caused by the fixation. Lower-extremity range of motion was regained rapidly, and each patient resumed essentially normal gait and activity. Addition of external-fixator stabilization aids greatly in wound care, as well as general ease of patient mobility and positioning. External fixation facilitates the use of cross-extremity flaps in pediatric patients in whom free tissue transfer may not be optimal.
authors.affiliation: Department of Orthopaedic Surgery, Bowman Gray School of Medicine, Medical Center, Winston-Salem, NC 27157-1070, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Mooney
authors.forename: A
authors.initials: A
authors.lastname: DeFranzo
authors.forename: M W
authors.initials: MW
authors.lastname: Marks
mesh_terms: D000063:Accidents, Traffic; D016512:Ankle Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps