Ilizarov talus bone lenghtening combined with multiple functional free flaps for reconstruction of a mangled hindfoot: A case report.

Introduction: Mangled hindfoot injuries with calcaneal defects and extensive soft tissue loss are foot-threatening, carrying high risks of infection and osteomyelitis. Currently, there is no standardized reconstructive protocol, though various methods have been applied. This case highlights a staged strategy combining vascularized flaps and the Ilizarov technique for such injuries, with an emphasis on controlling infection risks and reducing the need for bone grafting. Case presentation: A 38-year-old male with a right Gustilo-Anderson type IIIC calcaneal fracture (high-temperature crush injury) had soft tissue defects, third-degree burns, vascular compromise, and calcaneal loss. Staged management included: emergency ALT flow-through flap for vascular rescue, second ALT flap for soft tissue coverage, Ilizarov talar bone lengthening for osseous reconstruction, and medial plantar flap for a subsequent plantar ulcer. At 12-month follow-up, flaps were intact, Maryland Foot Score was 85, Visual Analog Scale (VAS) score of 2, and independent ambulation was achieved. Clinical discussion: This case demonstrates the efficacy of staged reconstruction: aggressive debridement reduced infection risk; Ilizarov technique enabled minimally invasive bone lengthening with infection control; flaps restored perfusion and soft tissue coverage, with the medial plantar flap preventing ulcer recurrence. No talar avascular necrosis was observed, but long-term follow-up is needed. Conclusion: Ilizarov talus bone lengthening combined with functional flaps transfer is a viable solution for severe posterior foot mangled injuries in osseous-soft tissue reconstruction.