Fig. 1

Case 1. A 24-year-old male patient with multiple fractures of the distal tibia and fibula complicated with soft tissue defects and infection for more than 1 month. Injury was caused by a traffic accident. Bone injury appearance upon admission and X-ray of the ankle joint (a, b). After thorough debridement and vacuum sealing drainage (VSD) of the right ankle, the granulation tissues on the wound surface grew well (c, d). During the second-stage procedures, FVFG was performed to reconstruct the infected bone defects (approximately 6 cm in size) at the distal tibia. The fascia lata of the same thigh was designed to repair the Achilles tendon defects. Simultaneously, the sural neurovascular flap of the right limb was reversely transferred to repair the Achilles tendon wound. The contralateral fibular bone flap, thigh fascia lata, and the ipsilateral sural neurovascular flap were harvested (e–g). Both the fibular flap and sural neurocutaneous flap survived well, and the wound was healed without exudation after operation (h). Postoperative X-ray showed that the FVFG repaired the distal tibial defects with excellent alignment (i). External fixator was removed 6 months postoperative and partial weight-bearing walk under the protection of the brace. At 1 year after operation, the internal fixator was removed, and normal walking function was restored. (j–m). After 24 months of postoperative time, the ASAMI functional score of the affected extremity was excellent, with an external fixation index 1.0