A 75-year-old man was diagnosed with Gustilo IIIB open fracture of forearm with extensor muscle group defect. Irrigation, debridement, and temporarily fixation with Kirschner wire were performed on the same day. On the 8th day of injury, the fracture was internally fixed with locking plates, and soft tissue reconstruction was performed using free latissimus dorsi (LD) flap for extensive muscle loss. Two months after the definitive surgery, reconstruction of the hand extension function was performed by the tendon transfer technique reported by Riordan. Three years after the definitive surgery, bone union and flap survival had been observed, and the functional outcome was excellent. In the present case, free LD flap was selected, but bulkiness was a problem. On the other hand, a relatively thin skin flap with fascia could have been performed as a cosmetic consideration. The advantages of reconstruction of extensor function with a two-stage tendon transfer procedure include obtaining a good range of motion of the fingers and wrist joints during the waiting period, which resulted in a good outcome in the present case.
