(A) A 38-year-old female patient visited the regional trauma center after falling from the 4-5th level of floor. By observation through the assessment of each part of body, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hemorrhage, cardiac tamponade, right atrium rupture, sternum fracture, pneumothorax, multiple rib fracture, traumatic hemothorax, lung contusion, traumatic hemoperitoneum were found. Apart from them, sacral fracture and acetabular fracture were diagnosed at pelvic part, lumbar vertebral burst fracture at spine. (B) Both talus body fracture, both calcaneus open fracture and right distal tibiofibular fracture were diagnosed at the both ankles, and at the time of visit, the patient was in coma with injury severity score 66, Gustilo–Anderson classification type IIIb. (C) When the vital signs became stabilized after the emergency operation by neuro and thoracic surgery, the initial orthopedic surgery (anterolateral thigh flap) could be performed, which was after 26 days. The treatment for the spinal fracture and cerebral hemorrhage was not completed but the flap procedure could be done successfully. Although other simpler techniques such as sural flap can be done, the scar remained at the donor site was considered because the patient was a young female. (D) After 8 months, the patient achieved the bone union, and the defatting of the flap area and cement bead removal were performed.

(A) A 51-year-old male patient was suspected of having a multiple trauma after a car accident and visited the regional trauma center, and he was diagnosed with traumatic hemothorax and lung contusion. (B) In orthopedic department he was diagnosed with left distal tibia open comminuted fracture and gastrocnemius muscle partial rupture. As an emergency surgery, the orthopedic surgeon performed the posterior decompression and fusion for the spine fracture, open reduction, irrigation and debridement, and external fixation for the left lower leg. (C) The inflammation at the left lower leg with skin loss showed an improvement, the anterolateral thigh flap was performed on the 8th day. The patient who had undergone a surgery for a spine fracture underwent the flap surgery but showed no complications. (D) After 6 months, he underwent a defatting and metal removal and at 7 months, the bone union was achieved.

The authors used the Pearson correlation coefficient method to confirm the correlation between the timing of the flap and the time of union. The p-value of 0.0688 showed no significant statistical significance but a positive correlation.