Complex Lower Extremity Salvage Using Composite Flap Grafting in COVID-19-Induced Arterial Thrombosis: A Case Report

We present a 42-year-old man who developed extensive left lower extremity arterial thrombosis following COVID-19 pneumonia. Despite multiple revascularization attempts and a below-knee amputation, he faced wound necrosis and insufficient soft tissue coverage. An innovative approach using a pedicled flap and sequential flow-through free flaps was used for limb salvage. Further interventions included through-knee amputation and targeted muscle reinnervation vs. nerve capping to address phantom limb pain.

This case demonstrates the potential of sequential flow-through free flaps in complex limb salvage when traditional revascularization is unfeasible, emphasizing early intervention and vigilant complication management.