A Case of Severe Necrotizing Soft-tissue Infection With Reconstruction of the Mid-lower Leg Using a Distally Based Pedicled Gracilis Muscle Flap.

Here, we report the management of a severe necrotizing soft-tissue infection involving the entire lower limb of a man in his 70s. The infection originated from a lower leg hematoma that developed during anticoagulant therapy for deep vein thrombosis. Necrosis extended from the deep thigh to the lower leg, involving areas surrounding critical structures such as the femoral artery, sciatic nerve, and tibia. Limb salvage was achieved through multiple debridement procedures and skin grafts performed in collaboration with orthopedic and cardiovascular surgery teams. The exposed cortical bone on the anterior midtibia was covered using a distally pedicled gracilis muscle flap in combination with negative-pressure wound therapy to avoid the need for a distal flap. The flap survived sufficiently to avoid a distal flap, and the patient was able to ambulate without a cane 6 months postoperatively.