Reconstruction of Lower Extremity Necrotizing Fasciitis with Tibialis Anterior Musculofascial Flap and Skin Graft: A Case Report

Abstract

Necrotizing fasciitis of the lower extremities results in large tissue defects, and most cases require reconstruction using skin grafts or flaps. We describe a 61-year-old man who developed necrotizing fasciitis of the right lower leg and septic shock, following a traumatic injury to his leg. Wound culture yielded methicillin-resistant Staphylococcus aureus. Extensive debridement was performed four times along with the use of appropriate antibiotics. After 2 weeks, physical examination showed an open wound (approximately 30×20 cm in size) with partial tibial bone exposure. Subsequently, the patient underwent successful reconstruction using a tibialis anterior musculofascial flap and split-thickness skin grafting. The tibialis anterior muscle was bihalved and pivoted to cover the exposed bone surface. The patient was without pain and was able to successfully perform daily activities at the 15-month follow-up. This case report highlights the utility of a bihalved tibialis anterior musculofascial flap for lower extremity reconstruction, particularly in patients for whom free flap transfers are unviable.