A case of an 18-year-old male with extensive posterior and lateral soft-tissue loss of the lower leg is reported. There was a segmental defect of 20 cm in the tibialis posterior neurovascular bundle, and the injury was not considered reconstructable. There was extensive soft-tissue trauma to the posterior compartments of the leg, with an intact and well-perfused foot. A primary amputation was indicated. The foot was used as a fillet flap for tibial length preservation and optimal stump coverage. The foot fillet flap was pedicled on the tibialis anterior vessels, preserving the deep plantar, first dorsal metatarsal, and anterior communicating vessels. The postoperative evolution was uneventful, with successful prosthetic adaptation.

Summary: High-energy lower limb trauma may result in complex defects with extensive vascular damage. Free flap reconstruction in these cases may require vein grafts to reach healthy proximal recipient vessels. Vascular loops are an increasingly popular technique in managing recipient vessels in reconstructive microsurgery, especially in the lower limb. The use of an entire omega segment of the greater saphenous vein had not been described before but offered two advantages: the caliber match for arterial repair was better using one of the limbs of the omega compared with the parent greater saphenous vein, and it allowed two venous anastomoses instead of one. A case report of a fully bifurcated segment of the greater saphenous vein as a vascular loop for microvascular reconstruction in the lower limb is presented. To the best of the authors’ knowledge, no similar case has been reported previously.

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The case presented here is a delayed reconstruction of a facial nerve defect after radical parotidectomy without a useful nerve stump at the stylomastoid foramen. A composite free flap was used to reconnect the nerve’s intrapetrous portion to the peripheral branches and reconstruct the soft-tissue deficit.

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