{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:14:05Z","timestamp":1783098845629,"version":"3.54.6"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,27]],"date-time":"2025-07-27T00:00:00Z","timestamp":1753574400000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Chronic osteomyelitis of the midfoot, particularly following high\u2010energy trauma such as a landmine injury, presents a formidable challenge due to the region's limited soft tissue envelope, complex anatomy, and the critical need for effective and durable dead space obliteration. While various flap options have been described, there remains no consensus on the optimal approach for managing deep defects in the midfoot, especially in cases complicated by prior surgical procedures. We present the case of a 23\u2010year\u2010old male who developed chronic midfoot osteomyelitis following a landmine explosion. Despite multiple debridements, targeted antibiotic therapy, and initial soft tissue coverage with an anterolateral thigh (ALT) flap, a persistent 6\u2009\u00d7\u20095\u2009cm (30\u2009cm<jats:sup>3<\/jats:sup>) dead space remained, consistent with a Cierny\u2013Mader type III\u2010A classification. A segmentally harvested gracilis muscle flap was designed and sculpted to conform to the dimensions of the cavity, then inset into the defect. Microvascular end\u2010to\u2010side anastomosis was performed to the anterior tibial artery and two accompanying veins, and the flap was covered with a split\u2010thickness skin graft. The postoperative course was uneventful at the recipient site. Mild serous drainage from the donor site, attributed to fat necrosis, resolved completely with conservative elastic compression therapy. At 12\u2010month follow\u2010up, the patient remained infection\u2010free, was fully ambulatory without assistance, and imaging confirmed complete obliteration of the dead space. This case suggests that a segmentally harvested gracilis muscle flap may offer a viable, anatomically conforming single\u2010stage option for managing complex midfoot osteomyelitis in selected patients. In individuals with prior treatment failure, this approach may help reduce surgical burden, enhance infection control, and support not only physical but also psychological recovery through resolution of a prolonged disease course.<\/jats:p>","DOI":"10.1002\/micr.70097","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T05:54:23Z","timestamp":1753682063000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Segmental Cylindrical Gracilis Free Flap for Dead Space Obliteration in Chronic Midfoot Osteomyelitis Secondary to Ballistic Injury: A Case Report"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3108-3297","authenticated-orcid":false,"given":"Erkan Sabri","family":"Erta\u015f","sequence":"first","affiliation":[{"name":"G\u00fclhane Training and Research Hospital Department of Orthopedics and Traumatology \u2013 Hand surgery  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,27]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2011.03.013"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000141377.00807.16"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19841001-07"},{"issue":"9","key":"e_1_2_5_5_1","first-page":"CD004439","article-title":"Antibiotics for Treating Chronic Osteomyelitis in Adults","volume":"2013","author":"Conterno L. 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