Abstract
Soft tissue injury in open fracture of the lower extremity represents a challenging trauma that requires complex strategies to reconstruct both bony and soft tissue defects. Various options are available to cover the soft tissue defect in the lower extremities, from simple skin grafting to local fasciocutaneous and muscle flaps. However, when the injury is extensive and involves a large surface area, options for treatment of local flap coverage become limited. Vascular injury (Gustilo type IIIc) further increases the risk of complications and flap failure. Despite these complexities, meticulous planning and attention to detail can optimize patient outcomes. Herein, we present a case of an open lower extremity fracture involving a substantial soft tissue defect over the proximal and middle segments of the tibia complicated by a vascular injury (Gustilo type IIIc). A combination of the hemigastrocnemius and hemisoleus muscles was implemented to cover soft tissue defect over the proximal two-thirds of the tibia despite significant popliteal artery compromise. This case underscores the feasibility of using a combined local muscle flap approach involving the hemigastrocnemius and hemisoleus muscles in managing open fractures with concomitant vascular injuries.