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Composite reconstruction was performed with internal fixation, cable autografting of the tibial nerve, and a functional latissimus dorsi musculocutaneous flap. A motor branch of the tibial nerve to the soleus was used as the donor motor nerve. The patient achieved a bony union and began ambulating at 8 weeks postoperatively. At 24 months, the patient was running and jumping with plantar push\u2010off. Recovery of plantar flexion was to the M5 level. Static and moving 2\u2010point discrimination of the plantar foot was 8 mm and 6 mm, respectively. Functioning muscle transfer in a child with a severe lower extremity injury with composite tissue loss may provide soft tissue and motor\u2010unit defect reconstruction with an acceptable functional restoration. \u00a9 2015 Wiley Periodicals, Inc. 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