Big tibial bone defects have different management options as bone transport, masquelet procedure or vascularized fibular transfer, however in some cases big bone defects is associated with extensive soft tissue lacerations together with poor ipsilateral blood supply. For those cases previous surgical options associated with many complications and may end up with failure, in this situation cross leg VFG is indicated.

Patients and methods:
Fifteen patients (13 males and two females) with average age 35 years (range 5-54 years) with tibial bone defect operated for cross leg FVFT. Average defect size was 18 cm (range 12- 26 cm). CT angiography was performed for all patients. Radial forearm flap was performed in all patients to be used as bridge between both limbs. Cross leg rigid external fixator was used in all cases to secure the vascular anastomosis. Flap separation was performed after 6 weeks.

Results:
Average follow up duration was 64 months (range 42- 95 months). All flaps survived monitored by the associated skin monitor. Primary union of the FVFG occurred at a mean of 4.5 months. All legs had satisfactory coverage and secondary bony procedures was done for eleven cases. The mean time to full weight – bearing following the reconstruction was 10 months.

Conclusion:
This technique is to be left as the last trial for limb salvage in cases of serious soft tissue leg defects where both local and regional flaps cannot be used, and the limb vessels are unsuitable for anastomosis.