Fortis Hospital in Delhi performs a 19th century procedure to save Iraqi national's leg

• The patient's legs had to overlap each other, and he had to be kept in that position for three weeks.
• A flap surgery involves lifting tissue from a donor site and placing it on the recipient site with an intact blood supply.
• The case was challenging because the patient had a severe infection and poor bone quality, the hospital said.

Doctors at a city-based hospital here treated a 40-year-old Iraqi national using the cross-leg flap surgery, an over a century-old technique, in which they lifted tissue from one site and placed it on the affected area.
The doctors at Fortis Hospital, Vasant Kunj, decided to perform the procedure - a technique arguably first described in medical literature in 1854 - as the newer and more sophisticated ones were not feasible due to the patient's precarious condition, the hospital said.

A flap surgery involves lifting tissue from a donor site and placing it on the recipient site with an intact blood supply.

It was considered the gold standard to reconstruct soft tissue defects of the lower limb during its heydays.

However, the technique fell into disuse with the advent of the highly sophisticated microvascular techniques, which enable doctors to join or repair damaged blood vessels or nerves, the hospital said.

The road accident victim, who had undergone three unsuccessful surgeries in Iraq in eight months, was brought to the hospital with acute dislocation of the left knee joint and a severely infected, pus-oozing leg, the hospital said.

Investigations revealed that the patient's affected leg had no intact blood vessel due to multiple injuries, which is necessary for the reconstructive surgeries currently in vogue. The doctors then decided to perform the cross-leg flap surgery.

"After much deliberation, we decided to adopt a complex, multi-step approach. Though the treatment spanned over five weeks, the outcome is satisfactory," said Dr Dhananjay Gupta, Director, Orthopaedics & Joint Replacement Surgery, Fortis Vasant Kunj.

"Presently, the patient's leg is well covered with soft tissue and there is no evidence of infection," he said.

"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," Gupta added.

The case was challenging because the patient had a severe infection and poor bone quality, the hospital said.

According to Dr Rashmi Taneja, Director, 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," she added.

The doctors had initially thought of doing a microvascular free flap reconstruction, which involves taking muscle and skin along with the blood vessels from either the back or the abdomen but had to abandon the idea as there was no intact blood vessel in the patient's leg.

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