ALT flap and reverse sural flap for simultaneous soft tissue coverage of both medial and lateral calf wounds in a diabetic patient.

Defects of the lower limb are generally difficult to correct, especially in patients with associated pathologies, and they represent a challenge for the reconstructive surgeon. The sural flap provides considerable versatility for lower limb reconstructions, successfully covering defects located between the knee and the ankle or the heel. Most frequently, this flap is used for defects located in the middle to distal third of the lower limb. The scope of reconstructing defects from the lower limb extremities must be concentrated both on covering the defect, and on functional recovery. When use of a local flap is insufficient, free flaps must be used, as they provide a wider coverage of defect. We report the successful surgical management of a case of a lower extremity injury consisting of a tibial pilon fracture, proximal fibula and lateral malleolus fractures, and a medium-to-large defect on both sides (internal and external) of the left ankle, on a 61 year-old patient, insulin dependent diabetic, heavy smoker, and with poor hygiene.