Successful four flap reconstruction for extensive crush injuries of bilateral lower limbs using local pedicled flaps in a 73-year-old patient: a rare case report

Abstract

Extensive soft tissue defects with periosteal stripping over critical areas of tibia pose a tough challenge to the reconstructive plastic surgeon. Treatment of choice for these defects is free tissue transfer. Local pedicled fasciocutaneous or muscle flaps are used only when the free tissue transfer is not possible. The gastrocnemius and soleus flaps either used as a combined flap or as individual separate flaps can be an alternate reconstructive option for these defects in selected cases. Here we report a 73-year-old male patient a case of extensive crush injury involving both lower limbs following a motor vehicle accident (MVA) in whom we have successfully reconstructed the extensive soft tissue defects with exposed tibia with four local pedicled flaps. The purpose of writing this case report is that when free tissue transfer is not possible in such extensive crush injuries, a durable functionally and cosmetically acceptable reconstruction with pedicled hemi gastrocnemius and medial hemisoleus flaps can be done after a meticulous planning and flap design without any significant functional donor site morbidity.