Surgeons at Fortis Hospital, Vasant Kunj, employed the cross-leg flap surgery technique in which tissue is lifted from one site and placed on the affected area with an intact blood supply.
They opted for the procedure, which first made an appearance in medical literature in the 1850s, because they determined that newer and more sophisticated procedures were not feasible due to the patient’s precarious condition.
The 19th century procedure used to be regularly employed to reconstruct soft tissue defects of the lower limb, however it fell into disuse with the advent of sophisticated microvascular techniques.
The patient, who had undergone three unsuccessful surgical interventions in Iraq in eight months, arrived at Fortis Hospital with an acute dislocation of the left knee joint and a severely infected leg.
As a result of multiple injuries, the patient’s affected leg had no intact blood vessel – a fundamental requirement for reconstructive surgery. This information prompted the doctors to perform the cross-leg flap surgery.
Fortis Vasant Kunj Director of Orthopaedics & Joint Replacement Surgery, Dr Dhananjay Gupta said: “After much deliberation, we decided to adopt a complex, multi-step approach. Though the treatment spanned over five weeks, the outcome was satisfactory.
“Presently, the patient’s leg is well covered with soft tissue and there is no evidence of infection.
“The patient has been asked to start walking and he is currently undergoing physio-rehabilitation.
“We hope that once the fracture heals, over a period of three months, he will be able to take his full weight on that leg.
“We have also planned for additional procedures in the future, which may be required.”
The case was challenging because the patient had a severe infection and poor bone quality.
According to Dr Rashmi Taneja, Director of Plastic & Reconstructive Surgery at Fortis VK, the patient was hypertensive and diabetic too.
“The patient’s legs had to overlap each other and he had to be kept in that position for three weeks.
“So, placing it in a manner where there’s no pressure between the two feet and making sure that there is no bending of the flap while it is taking up the new circulation was challenging and required planning and of course cooperation of the patient.”
