Full Tibialis Anterior Muscle Turnover Flap for Distal Tibial Coverage in a High-Risk Patient With Ankle Arthrodesis: A Case Report.

Distal tibial wounds with exposed bone or hardware pose a reconstructive challenge, particularly in medically high-risk patients unsuitable for free flap reconstruction. The tibialis anterior muscle is rarely used for reconstruction because sacrifice of the muscle may result in loss of ankle dorsiflexion. However, in selected patients with ankle arthrodesis, complete tibialis anterior sacrifice may be more acceptable because active ankle dorsiflexion is no longer essential. This case report describes a 66-year-old woman with significant cardiopulmonary comorbidity who developed anterior distal tibial wound dehiscence with exposed bone and hardware following revision ankle arthrodesis. After debridement, removal of infected hardware, antibiotic therapy, and negative-pressure wound therapy, definitive coverage was achieved using a full tibialis anterior muscle turnover flap with split-thickness skin grafting. The muscle was mobilised and turned medially over the distal tibial defect and inset without tension. The flap and graft healed successfully, infection was controlled, and the limb was salvaged while the arthrodesis was protected in immobilisation. In this high-risk patient with an ankle fusion, a full tibialis anterior turnover flap provided reliable coverage of a distal tibial wound without producing a clinically meaningful functional deficit. This case demonstrates how altered biomechanics following ankle arthrodesis may expand the role of local flap reconstruction and offers a useful limb-salvage option when microsurgical reconstruction is undesirable or contraindicated.