Reconstruction of an extensive tibial soft-tissue defect with multiple local muscle flaps for limb salvage when free-tissue transfer was not an option

The use of microvascular free-tissue transfer for stable soft-tissue coverage has all but replaced the use of local muscle flaps to provide for reliable soft-tissue coverage of an extensive tibial wound. However, free-tissue transfer may not be an option of choice for patients with an extensive tibial defect for various reasons. We present two cases of extensive tibial soft-tissue defect that were managed successfully by multiple local muscle flaps with skin grafts. Both patients had complete healing of their wounds with only minimal complications. These cases demonstrate that an extensive tibial soft-tissue defect can be reconstructed with innovative use of multiple local muscle flaps. This approach is a good alternative to free-tissue transfer for limb salvage, and should be offered to patients with an extensive tibial wound when free-tissue transfer is not an option.