Fig 1.

A 50-year-old patient presented with a non-healing chronic wound and osteomyelitis of the tibia in the left pretibial region. The wound was more than 12 months old and 2 × 1 × 1 cm in size (A). The patient was planned to undergo a staged procedure. After debridement, biopsies were taken and TNP was applied. After 5 days of TNP the dressing was removed and the wound bed looked well vascularized (B). Again biopsies of the wound bed and edge were taken and defect coverage was achieved using a distally pedicled Arteria tibialis anterior perforator flap with a size of 9 × 3.5 cm and split skin graft on the donor side. Three months post-operatively stable defect closure was obtained and the patient was mobilized (C).