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

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.