Background: Cross-leg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. However, there are certain difficult situations where the free flap cannot be employed and alternative methods are needed. We describe our experience with cross-leg flap in 135 patients for the reconstruction of difficult leg defects in which no possible other options available for reconstruction of the defect. Materials and Methods: This study was carried upon one hundred thirty five patients suffering from leg and-or foot soft tissue injury. This study focused on the cases that need coverage of bone, tendons, and neurovascular bundle, while those that managed by local flap or split thickness graft were excluded. Results: All patients ambulate well after 5 - 10 days, except for 14 patients who had associated orthopedic problems as external fixation, or other fractures. Cosmetic outcome were excellent in all patients, but 3 patient’s mothers complaint of bulky flap, and for them liposuction was done with postoperative satisfaction. 2 cases complaint of early donnar sit graft, but later on they were satisfied. Conclusion: Cross-leg flap offers the possibil- ity of salvaging limbs that are otherwise nonreconstructable.
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