Use of cross-leg latissimus dorsi free flap for repair of extensive lower leg electrical injury in a child

Abstract

Extensive electrical injury to the distal part of the lower extremity presents a difficult reconstruction problem to the plastic surgeon. The amputation rate of the lower extremity in patients with high-voltage electrical injuries is reported as 40% [1]. Providing vascularized tissue to the injured area has been advocated as a method to improve outcome in electrical injuries [1]. The usefulness and reliability of muscle flaps diminish in the distal third of the leg. Early reconstruction with microvascular tissue transfers became the method of choice especially for large soft tissue defects due to condition of patient, microsurgical skill of surgeon and availability of suitable recipient vessels in defect area. Microvascular surgery in children is safe and carries a high success rate which was reported by Parry et al. [2]. Cross-leg free flaps have been described for reconstruction of leg defects in cases of trauma with no suitable recipient vessels in the vicinity of the defect. Vascular pedicle of the free flap can be temporarily anastomised to the recipient vessels in the contralateral leg and then divided after adequate neovascularisation of the flap occurs from the recipient bed. We present a 7-year-old child who sustained a high voltage burn to his right upper extremity and bilateral lower extremities. A pedicled latissimus dorsi flap was used to