Staged Orthoplastic Soft-Tissue Reconstruction of Complex Tibial Fracture-Related Infection Using a Chimeric Anterolateral Thigh Free Flap After Failed Soleus Muscle Flap: A Case Report
- 1Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China
Abstract
A complex tibial fracture-related infection (FRI) after local-flap failure may require staged source control, dead-space management, and vascularized soft-tissue reconstruction. A 60-year-old man with type 2 diabetes developed FRI after an industrial injury causing a localized incomplete open tibial fracture with preserved alignment and no large segmental bone defect. Previous debridements, cement-based dead-space management, negative-pressure wound therapy, and soleus muscle-flap transfer failed. On 4 June 2026, repeat radical debridement was followed by temporary vancomycin-loaded polymethylmethacrylate for dead-space management. On 25 June, the cement was removed, repeat debridement was performed, and a 16 cm × 7 cm defect with exposed tibia and tendon and a large proximal dead space was reconstructed using a chimeric anterolateral thigh–vastus lateralis free flap. No additional skeletal reconstruction was required. At 9.5-week follow-up, the flap remained fully viable with stable coverage; CRP was 2.0 mg/L, IL-6 was 3.8 pg/mL, and ESR was 22 mm/h. This case illustrates a staged orthoplastic salvage strategy after local-flap failure. Longer follow-up is required to confirm definitive infection control, fracture union, and function.
Related
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BibTeX
@article{liao2026staged,
title = {{Staged Orthoplastic Soft-Tissue Reconstruction of Complex Tibial Fracture-Related Infection Using a Chimeric Anterolateral Thigh Free Flap After Failed Soleus Muscle Flap: A Case Report}},
author = {Chang-Sheng Liao and Xia Chen and Feng-Jun Lan and Huan-Sheng Liu and Qiang Huang and Yong-Xi Fan},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207804},
url = {https://www.mdpi.com/2077-0383/15/20/7804},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Staged Orthoplastic Soft-Tissue Reconstruction of Complex Tibial Fracture-Related Infection Using a Chimeric Anterolateral Thigh Free Flap After Failed Soleus Muscle Flap: A Case Report
AU - Chang-Sheng Liao
AU - Xia Chen
AU - Feng-Jun Lan
AU - Huan-Sheng Liu
AU - Qiang Huang
AU - Yong-Xi Fan
PY - 2026
DA - 2026/10/10
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207804
UR - https://www.mdpi.com/2077-0383/15/20/7804
AB - A complex tibial fracture-related infection (FRI) after local-flap failure may require staged source control, dead-space management, and vascularized soft-tissue reconstruction. A 60-year-old man with type 2 diabetes developed FRI after an industrial injury causing a localized incomplete open tibial fracture with preserved alignment and no large segmental bone defect. Previous debridements, cement-based dead-space management, negative-pressure wound therapy, and soleus muscle-flap transfer failed. On 4 June 2026, repeat radical debridement was followed by temporary vancomycin-loaded polymethylmethacrylate for dead-space management. On 25 June, the cement was removed, repeat debridement was performed, and a 16 cm × 7 cm defect with exposed tibia and tendon and a large proximal dead space was reconstructed using a chimeric anterolateral thigh–vastus lateralis free flap. No additional skeletal reconstruction was required. At 9.5-week follow-up, the flap remained fully viable with stable coverage; CRP was 2.0 mg/L, IL-6 was 3.8 pg/mL, and ESR was 22 mm/h. This case illustrates a staged orthoplastic salvage strategy after local-flap failure. Longer follow-up is required to confirm definitive infection control, fracture union, and function.
SN - 2077-0383
ER -