Medial Gastrocnemius Tenocutaneous Island Flap: A Salvage Option After Free Flap Compromise in the Lower Limb

Lower limb salvage following free flap compromise poses a significant reconstructive challenge, particularly when managing complex defects with exposed bone or hardware. Despite advances in microsurgical techniques, the medial gastrocnemius flap, known for its reliable vascular anatomy and versatility, remains a valuable option in such scenarios. In this case report, we present the effective use of a medial gastrocnemius tenocutaneous island flap for reconstructing a complex defect in the middle third of the leg following partial free flap failure. This approach provided successful coverage of exposed structures, preserved limb function, and prevented further complications. Our experience highlights the adaptability and utility of the medial gastrocnemius tenocutaneous island flap in lower limb salvage, especially for wounds located in the middle third of the leg, underscoring its role as a good option in complex reconstructive cases.