Abstract
INTRODUCTION: Blast injuries to the lower extremities often result in extensive soft tissue damage and are prone to complications such as infection and, rarely, maggot infestation. These challenges can jeopardize limb salvage, especially in resource-limited settings. We report a successfully managed case of a neglected anterior ankle blast wound complicated by infection and myiasis, treated with a multidisciplinary approach incorporating sunlight exposure and a cross-leg flap. CASE PRESENTATION: A 38-year-old woman presented with a 20-day-old anterior ankle blast injury complicated by infection, necrosis, and maggot infestation. After initially declining amputation, she was treated at our institution with serial debridement, systemic antibiotics, nutritional support, and adjunctive sunlight exposure. Due to extensive tissue loss and compromised local vascularity, a cross-leg flap supported by external fixation was selected for definitive coverage. Postoperative ischemic changes in the flap were noted but improved significantly with resumed sunlight therapy. Flap division and split-thickness skin grafting were successfully performed three weeks later, resulting in complete wound healing and functional recovery. DISCUSSION: Maggot infestation, although rare-especially following blast trauma-demands aggressive debridement, meticulous hygiene, and strict infection control. Cross-leg flaps remain a valuable reconstructive option when local tissue transfer or free flaps are not feasible. In this case, sunlight therapy, an unconventional adjunct, showed clinical benefit by enhancing local wound care and flap viability. CONCLUSION: This case highlights the importance of multidisciplinary, adaptable approaches for complex limb injuries. Cross-leg flaps and non-traditional interventions like sunlight exposure may be effective strategies in low-resource settings.