The Composite Radial Forearm Free Flap for Tibialis Anterior Tendon Reconstruction: A Case Report.

Distal leg reconstruction is particularly challenging due to limited local options. This challenge is accentuated when there is a concurrent tendon rupture and threatened hardware, making soft tissue coverage crucial for preserving limb function. This report describes a 37-year-old male with a 5 × 8 cm wound on the distal leg, including a 7.5 cm loss of tibialis anterior tendon (TAT) with underlying tibial hardware. A 5 × 9 cm composite left radial forearm free flap (FF), including flexor carpi radialis and palmaris longus tendons, was used to reconstruct the TAT and cover the tibial hardware. The patient's postoperative course was smooth, and he was able to walk without assistance after 6 weeks. At 10 months, the patient continued to show strong ankle dorsiflexion and ambulated independently. This case demonstrates that a composite radial forearm FF may be an effective autologous option for simultaneous soft tissue coverage and tendon reconstruction in the lower extremity.