Combined Use of the Hemi-Gastrocnemius Muscle and Split Tibialis Anterior Muscle Flap for Reconstruction in a Necrotizing Fasciitis Patient

Abstract

Background: Soft tissue reconstruction of the lower limb following trauma or necrotizing fasciitis presents significant challenges in preserving both function and appearance. This case report demonstrates the clinical feasibility and functional success of using a combination of hemi-gastrocnemius and split tibialis anterior muscle flaps for coverage of extensive anterior tibial defects caused by necrotizing fasciitis. Case presentation: A 30-year-old male with uncontrolled diabetes presented with severe tissue loss and tibial bone exposure after multiple debridement. To salvage the limb, a medial hemi-gastrocnemius muscle flap was used for the proximal defect, and a longitudinally split tibialis anterior flap was applied distally. Both flaps remained viable, and complete wound closure was achieved with split-thickness skin grafting in same operation. The ankle dorsiflexion function and independent ambulation were intact following physiotherapy. This method allowed effective soft tissue coverage without microsurgical intervention and minimized donor site morbidity. Conclusion: Though rarely used worldwide, the combined use of hemi-gastrocnemius and split tibialis anterior muscle flaps offer reconstructive surgeons a reliable, function-preserving solution especially in resource-limited settings where conventional or free flaps are not feasible due to anatomical or systemic limitations.

J Shaheed Suhrawardy Med Coll 2025; 17(1): 111-114