Although several studies exist on the simple volume filling of soft tissue defects in lower extremity reconstruction, few reports have described functional reconstruction. In this study, a 52-year-old male patient, after a forklift accident, developed soft tissue defects of the all the right dorsiflexors. The patient underwent surgery with a chimeric anterolateral thigh free flap (cALT-FF), in which 18×8 cm2 fasciocutaneous flaps were harvested, including a 6×9 cm2 vastus lateralis muscle flap in a chimeric pattern. The functionality of the lower extremities was evaluated in terms of the active ankle-dorsiflexion range of motion and the Stanmore system after 15 months, and the result was good. In this study, we focused on functional reconstruction following the use of cALT-FF in a patient with defects of all the dorsiflexor muscles, which play an important functional role in gait.

The fibular free flap (FFF) is an option used for tibial defect reconstruction in post-traumatic chronic osteomyelitis (PCOM). However, as the tibia is a weight-bearing bone, there exists a risk of compression fracture risk after FFF. This complicates reconstructing distal tibial defects adjacent to the articular cartilage. We report a successful case of reconstruction using FFF for a bone defect adjacent to the distal tibial articular surface in refractory PCOM. The patient was a 73-year-old woman with refractory PCOM in the right distal tibia secondary to a tibial fracture from a traffic accident that occurred 28 years ago. After bone debridement, the tibial bone defect was 8 cm in length, and its distal margin was located 0.5 cm above the articular surface of the tibiotalar joint. Tibial bone and soft tissue defects were reconstructed using a contralateral FFF consisting of an 8-cm fibula bone and a 14×5-cm-sized skin paddle. After 2 months, an Ilizarov apparatus was applied and maintained for 3 months. After 6 months, she started weight-bearing. The follow-up period was 15 months. Imaging studies revealed bone block union. The patient displayed no difficulty in ambulation and had no additional infections or flap necrosis.