Staged reconstruction of the traumatic large soft-tissue defect in the leg

We present a case of an elderly female patient with a chronic lower leg wound involving bone exposure in the tibia. Despite the absence of overt infection, low-grade osteomyelitis was suspected. Given the patient's age and overall fitness, we opted for a staged reconstructive approach using negative pressure wound therapy (NPWT), followed by sequential pedicled muscle flaps and skin grafting. This method was favored over free flap reconstruction due to patient-specific factors and the aim of minimizing donor site morbidity. The outcome was functionally and aesthetically satisfactory, with no signs of flap failure or recurrent infection.

This case highlights the utility of staged reconstruction using local muscle flaps combined with NPWT in elderly patients, offering a limb-salvaging alternative to free tissue transfer in selected cases.