case_images: PMC6457015_01
case_images: (a) Left tibiofibular shaft open fracture (Gustilo grade IIIb). (b) Left
  lower leg open fracture contaminated by roadside soil. (c) The orthopedic
  surgeon performed open reduction and internal fixation of the tibiofibular
  fracture. (d) We performed an ALT musculocutaneous flap, harvested from the
  ipsilateral leg, for defect reconstruction. Recipient vessels were the
  anterior tibial artery and its concomitant veins. (e) The patient's
  postoperative course was uneventful. However, the proximal part of the flap
  started to show mild bluish changes 9 days following reconstruction. (f) The
  size of the affected area gradually increased day by day, and dry gangrenous
  changes ultimately developed over the proximal one-third of the by 35 days
  following reconstruction.
case_images: 10.1177_2050313X19841963-fig1.jpg
case_images: PMC6457015_01_10.1177_2050313X19841963-fig1.jpg
case_images: fig1-2050313X19841963
case_images: This report is about a 62-year-old male with uncontrolled type II diabetes mellitus diagnosed 4 years ago and an open tibiofibular fracture of the left lower extremity caused by a traumatic motorcycle accident (Gustilo grade IIIb) (Figure 1(a) and (b)). After open reduction and internal fixation, an anterolateral thigh (ALT) myocutaneous flap was harvested to cover the exposed bone and for defect reconstruction (Figure 1(c) and (d)). The proximal part of the flap began showing a mild bluish change 9 days following reconstruction (Figure 1(e)). The size of the affected area gradually increased, and dry gangrenous changes ultimately developed over the proximal one-third of the flap 35 days following reconstruction (Figure 1(f)).
case_images: (a) Orange cottony colonies grew on the Sabouraud dextrose agar. (b)
  White-cottony colonies grew on the brain heart infusion agar. (c) Cover
  slide under a light microscope showed septated hyphae with acute branching
  (lactophenol cotton blue stain, x1000). (d) Cone-shaped microconidia, the
  characteristic of Fusarium (lactophenol cotton blue stain,
  x1000). (e) Debridement of the gangrenous flap was performed on 35 days
  following reconstruction. (f) The periodic acid Schiff stain demonstrates
  septated, acute angled fungal hyphae, and spores in the tissues from the
  left lower leg (x1000).
case_images: 10.1177_2050313X19841963-fig2.jpg
case_images: PMC6457015_01_10.1177_2050313X19841963-fig2.jpg
case_images: fig2-2050313X19841963
case_images: An infectious disease specialist used standard mycological procedures and grew Fusarium species from two separate cultures at different intervals (Figure 2(a) and (b)). A light microscope examination with lactophenol cotton blue stain revealing septated and acute branching hyphae with microconidia spores (Figure 2(c) and (d)). Debridement of gangrenous flap (Figure 2(e)) was performed at 35 days following reconstruction. Specimen pathology revealed a deep fungal infection with clustered fungal spores and septated, acute angled hyphae with extensive necrosis of adjacent tissues (Figure 2(f)).
case_images: At 2-year follow-up, the flap was viable with adequate bone union.
case_images: 10.1177_2050313X19841963-fig3.jpg
case_images: PMC6457015_01_10.1177_2050313X19841963-fig3.jpg
case_images: fig3-2050313X19841963
case_images: We arranged for a split-thickness skin graft from the ipsilateral leg, and at 2-year follow-up, the flap was viable with adequate bone union (Figure 3).