Treatment strategies for open fractures are being established; however, reconstruction of open fractures with extensive soft tissue defects remains challenging. Herein, we report a case of an open fracture of the lower leg with extensive soft tissue defects successfully reconstructed using a combined flap. A 65-year-old man sustained an open fracture of his right lower leg with a large soft tissue defect following a motorcycle accident. Following debridement, a skin defect extended from the proximal 1/4 of the lower leg to the heel, requiring a flap coverage of approximately 42 cm in length. After osteosynthesis, the extensive soft tissue defect was reconstructed using a combined latissimus dorsi and intercostal artery perforator free flap on the eighth day post-injury. Several intercostal artery perforators, identified using preoperative ultrasonography, were secured during flap harvest, and an appropriate perforator was supercharged. Nine months post-injury, the flap has survived, and the patient is ambulatory. The combined flap was effective for reconstruction of open fractures with extensive skin defects that could not be adequately covered by a single flap.
