Cross-leg pedicled fibular graft--a new reconstructive method with vascularized bone graft

Theoretical foundations for cross-leg pedicled fibular graft, a new method for reconstruction within lower extremity with vascularized bone graft is presented. The flap can be raised in two fashions depending on blood flow direction in the pedicle. In case of regular flow up to 18 cm of fibula is available; in reversed pedicular flow over 20 cm of fibula can be harvested. An arch of rotation of the flap reaches mid-thigh and peripheral part of the lower extremity. Cross-leg pedicled fibular graft can be used for concomitant soft tissue defect reconstruction as well. Crossing and immobilization of both lower extremities is necessary for 4 weeks. No microsurgical procedure is required. Skin island of the fibular flap or narrow muscular cuff left around fibular vessels is sufficient to protect the pedicle. Main indication for cross-leg pedicled fibular flap include patients with major lower extremity injury with axial vessels damage or with history of previous trauma and thrombosis, and patients after bone tumor resection who had chemotherapy and/or radiotherapy. The indications may be markedly broadened especially in centers with no access to microsurgery. The results of this method are very encouraging so far.