Critical steps in the perfusion of a walking cross-leg flap monitored with dynamic infrared thermography. Case report

Abstract

A walking cross-leg flap is a cross-leg flap that reaches its destination not in one but in several steps. It may be the last option before leg amputation. Knowledge on the perfusion of these flaps may optimize its use, reduce the risk for complications and improve our knowledge on flap survival. Dynamic infrared thermography (DIRT) was used to evaluate the perfusion during the critical steps of flap transfer of a walking cross-leg flap. DIRT showed that a perforator at the recipient site had connected to the fasciocutaneous perforator vasculature of the walking cross-leg flap. Flap perfusion during transfer of the walking cross-leg flap to its destination was based on this perforator and led to a reversed blood flow direction within the walking cross-leg flap through this perforator. DIRT also helped to define the time of pedicle division as it showed the location and the hemodynamics of the newly formed perforator.