Tissue coverage of lower limb defects after tibial fractures remain one of the hardest areas for a surgeon to deal with. The definitive management of Gustillo type IIIB fractures depends on a series of factors, which have a high impact in the multidisciplinary management of this severe trauma. Although free flaps have been used succesfully in the last two decades, there remains some cases where easier plasties using the contralateral limb tissue reserved could be indicated. We describe our experience with a cross-leg flap in a severe-smoking patient for the reconstruction of a difficult leg defect.
