Lower-Limb Salvage Procedure using Anterolateral Thigh Free Flap and Multiple Tendon Grafts in a Road Injury Patient: A Case Report

Introduction: The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of adequate recipient vessels when the tibial arteries result damaged. In this scenario, vein grafts can be interposed to connect a healthy recipient vessel to the ALT flap pedicle. Case Report: We present a report of a 19-year-old male who suffered a Gustilo fracture type IIIc after a road injury involving the right lower limb. After a failed first attempt of limb salvage with reconstruction of extensor tendons and a free ALT flap, a second procedure was performed using another ALT flap with interposed vein grafts to reach very proximal recipient vessels. Results: The patient demonstrated excellent recovery and restored ambulation. The effectiveness of the most complex reconstructive options for a high-demanding patient with no comorbidities is demonstrated in this case. Conclusion: The key to success in even the most complex injury cases is early intervention, meticulous surgical planning, and a multidisciplinary approach. Keywords: Anterolateral thigh flap, vein graft, gustilo fracture, ankle, tendon graft, limb salvage.