Surgical images: musculoskeletal: Sural neurocutaneous cross-leg flap

A7-year-old girl presented to the multinational medical unit at Kandahar Airfield with an open lateral malleolus fracture secondary to a blast injury. Serial d�bridement procedures preceded a vacuum-assisted closure dressing applied for 8 days (Fig. 1). Flap coverage was needed, and because of the location and size of the wound, no local options were feasible. The ipsilateral lesser saphenous vein and sural nerve had been injured, and there was no access to microsurgical expertise.

Although currently out of favour, a cross leg flap was chosen in this case. A sural neurocutaneous flap was harvested from the contralateral leg. An external fixator was then applied to hold the legs …