Neurosensorial and clinical comparison of the free fasciocutaneous cross-leg flaps and free conventional fasciocutaneous flaps used in the reconstruction of soft tissue defects of the lower extremity

In reconstrutive surgery, one of the goals is repairing the tissue with similar tissue in defected area of the body. Free flaps are so important in order to prevent amputation of the lower limb with extensive soft tissue defects. A suitable recipient vessel must be available in the defected part of the extremity. If the appropriate recipient vessel is not available, the defect can be reconstructed by using the vessels of the contralateral leg. In order to achieve complete reconstruction of the defect, neurosensorial function has to be provided additionally. Areas such as mouth, breast tissue and soles of the feet are far more important than the other regions in terms of sensorineural function. In this study, we compared the free fasciocutaneous conventional flaps with free fasciocutaneous cross-leg flaps in neurosensory and clinical terms. In November 2018 and December 2018, from patients who visited our clinic, the patients who had surgical history with free fasciocutaneous conventional flaps and free fasciocutaneous cross-leg flaps were chosen and analysed. None of the patients had sensory nerve repair during the operation. There were 24 patients and half of them had free fasciocutaneous conventional flap surgery and the other half of the patients had free fasciocutaneous cross-leg flap surgery. The ages of patients ranged from 18 to 70 and the follow-up period of the patients ranged from 12 to 86 months. The flap type used (anterolateral thigh free flap) in all patients was the same. These patients were evaluated with light touch, hot-cold sensation, painful stimulation, sensorial examination with Semmes Weinstein monofilament test and temperature of the flap zones with integrated thermal camera. In the evaluations performed, it was observed that the light touch sensation was better in the peripheral regions of the flap in all patients than in the central region. It was observed that the light touch sense was better in the upper part of the flap, medial and lateral part of the free cross-leg flap group compared to the free conventional flap patients. No significant difference was observed in the lower part of the flaps and central regions. In the evaluation performed with Semmes Weinstein test, it was observed that the sensitivity of the touch sensation was better in the donor regions compared to the flap region. In this test, it was observed that the upper part, medial part, lower part and central part of the free fasciocutaneous cross-leg flaps had better sensory function compared to the patients who had free fasciocutaneous conventional flaps. No significant difference was observed in flap tissue temperature measurement with thermal camera in both groups. As a result, we concluded that the flap tissue is more regenerated in the peripheral zone with axonal sprouting in the lower extremity defects in patients who had undergone free flap surgery. In our study, we found that free fasciocutaneous cross-leg flaps has better neurosensorial function than free conventional flaps.