Severe soft tissue defects of the foot in patients with diabetes mellitus complicated by septicemia pose a significant reconstructive challenge and are frequently associated with a high risk of amputation. Limb salvage in such cases requires aggressive infection control, meticulous debridement, and reliable soft tissue coverage. We report the case of a 57-year-old man with poorly controlled diabetes who developed an extensive dorsal foot defect following trauma, complicated by infection. After serial debridement and optimization of systemic condition, reconstruction was performed using an anterolateral thigh free flap. Microvascular anastomosis was successfully achieved using the dorsalis pedis artery and venae comitantes. The postoperative course was uneventful, with complete flap survival and no recurrence of infection. At the six-month follow-up, both donor and recipient sites were well healed, and the patient regained functional ambulation. Although the flap appeared cosmetically bulky, it provided durable coverage and prevented amputation. This case highlights the effectiveness of an anterolateral thigh free flap in achieving limb salvage in high-risk diabetic patients, emphasizing that functional preservation should take precedence over cosmetic outcomes.
Zin et al. (2026) studied this question.