Soft tissue reconstruction is crucial in Gustilo typeⅢB open lower leg fractures, free flap reconstruction is indicated when defects are extensive. In lower leg soft tissue reconstruction, the anterior tibial artery (ATA) or posterior tibial artery is commonly selected as the recipient vessel for free flaps among the major arteries of the lower leg. However, no consensus exists regarding reconstruction methods or the selection of recipient vessels and anastomotic techniques when these major arteries are occluded. In this case, we performed free flap reconstruction using a latissimus dorsi muscle flap with the medial sural artery (MSA) as the recipient vessel in a Gustilo typeⅢB open lower leg fracture complicated by ATA occlusion, achieving favorable results. The MSA may be a useful option as a recipient vessel for reconstruction of open lower leg fractures complicated by occlusion of major arteries or in single-vessel limbs.
