Reverse Sural Flap for Reconstruction of a Distal Leg Soft-Tissue Defect Following Dog Bite Injury: A Case Report.

Dog bites are a frequent cause of extremity trauma and pose a substantial risk of infection and complications, particularly when bone exposure is present. We present the case of a 58-year-old male with no comorbidities who arrived at the emergency department after being attacked by a dog while cycling, sustaining multiple bites to the left lower extremity and right forearm. On physical examination, the patient exhibited complex wounds measuring up to 10 × 5 cm, with muscular and tibial bone exposure in the left leg but no associated fracture, and additional forearm lesions with muscle exposure but preserved tendon and neurovascular structures. Hemodynamic parameters were stable, while laboratory tests revealed marked leukocytosis (30,000/µL). The patient underwent urgent surgical irrigation, radical debridement, partial wound closure, and empiric intravenous antibiotic therapy on the day of admission. Due to persistent tibial bone exposure, definitive reconstruction with a distally based reverse sural flap was performed five days later, following serial wound care and infection control. The postoperative course was uneventful, with complete flap viability and 95% graft take by postoperative day seven, enabling discharge with oral antibiotics and local wound care. This case underscores the critical importance of prompt surgical and multidisciplinary management in complex dog bite injuries and further supports the reverse sural flap as a reliable, reproducible, and effective reconstructive option for coverage of distal leg defects with bone exposure.