Staged reconstruction of the traumatic large soft-tissue defect in the leg.

[CASE] We present a case of an elderly female patient with a chronic lower leg wound involving bone exposure in the tibia. Despite the absence of overt infection, low-grade osteomyelitis was suspected. Given the patient's age and overall fitness, we opted for a staged reconstructive approach using negative pressure wound therapy (NPWT), followed by sequential pedicled muscle flaps and skin grafting. This method was favored over free flap reconstruction due to patient-specific factors and the aim of minimizing donor site morbidity. The outcome was functionally and aesthetically satisfactory, with no signs of flap failure or recurrent infection.

[CONCLUSION] This case highlights the utility of staged reconstruction using local muscle flaps combined with NPWT in elderly patients, offering a limb-salvaging alternative to free tissue transfer in selected cases.