A 35-year-old patient has a full-thickness defect of the anterior leg following debridement of necrotising fasciitis. The tibia is exposed with viable periosteum present. The reconstructive approach following the 'reconstructive ladder' that is most appropriate at this stage is:

• A Free muscle flap (e.g., latissimus dorsi or rectus abdominis) ✓
• B Split-skin grafting directly over the exposed bone
• C Local random-pattern cutaneous flap
• D Topical negative pressure therapy and primary closure at 6 weeks

Explanation

A full-thickness leg defect with exposed bone (even with periosteum) requires vascularised tissue coverage because split-skin grafts cannot take directly on cortical bone without periosteum, and local flaps are generally insufficient for large anterior leg defects. Free tissue transfer (free muscle flap with skin graft, e.g., latissimus dorsi free flap) is the gold-standard reconstruction for complex leg defects with exposed bone, providing vascularised tissue that resists infection and promotes healing. The reconstructive ladder escalates from simplest to most complex as required.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.