A Chimeric SCIP Flap With a Sartorius Muscle Component for Single-Stage Reconstruction of Late-Onset Navicular...

In degloving injuries without associated fracture, osteomyelitis may be difficult to recognize, potentially delaying definitive treatment. We report a case and describe the role of a chimeric superficial circumflex iliac artery perforator (SCIP) flap with a sartorius muscle component for simultaneous dead-space obliteration and soft-tissue resurfacing. A 44-year-old man underwent free anterolateral thigh flap coverage 1 month after a medial ankle degloving injury. Two years later, a painless noninflammatory cystic lesion developed on the flap and recurred over 4 years despite three local debridements. At 6 years after injury, ultrasound, computed tomography, and magnetic resonance imaging demonstrated a sinus tract communicating with the navicular bone. Definitive debridement identified a retained anchor fragment within the navicular fistula and purulent tissue along the tract, resulting in a 4 × 10 cm soft-tissue defect and an approximately 7 × 8 × 14 mm intraosseous dead space. Single-stage reconstruction was performed using a chimeric SCIP flap with a 12 × 5 cm skin paddle and a 6 × 4.5 cm sartorius muscle segment. The muscle component obliterated the navicular cavity, and the skin paddle resurfaced the medial ankle defect. Culture grew Pseudomonas aeruginosa, and targeted antibiotics were administered for 14 weeks. Healing was uneventful. At 1 year, the patient remained symptom-free without recurrence. The erythrocyte sedimentation rate had returned to the normal range, and MRI showed resolution of navicular marrow edema. This case highlights the importance of thorough imaging in recurrent wound problems after degloving injury, even when the initial injury appears limited to the skin and soft tissue. A chimeric SCIP flap with a sartorius muscle component may be a useful single-stage option for osteomyelitis treatment requiring dead-space obliteration and thin soft-tissue coverage.