Effective Limb Salvage Using a Distally Based Peroneus Brevis Flap for Distal Tibial Osteomyelitis.

Post-traumatic osteomyelitis of the distal third of the tibia represents a significant reconstructive challenge due to limited soft-tissue coverage, poor vascularity, and a high risk of recurrent infection. We present the case of a 60-year-old diabetic male patient who developed chronic osteomyelitis following traumatic injury to the lower third of his leg. The patient underwent staged management, including radical debridement, culture-directed antibiotic therapy, autologous cancellous bone grafting, and soft-tissue reconstruction with a distally based peroneus brevis muscle flap. Complete wound healing and full restoration of limb function were achieved without recurrence of infection. This case underscores the effectiveness of the peroneus brevis flap as a reliable, technically straightforward, and resource-efficient alternative to microsurgical free flaps for distal tibial defects. When combined with thorough infection control and skeletal reconstruction, this approach provides a practical and successful limb-salvage solution for chronic distal tibial osteomyelitis.