Background: reconstruction of the plantar aspect of the foot requires tissue that is durable and will be able to tolerate extremes of direct pressure and shear stress. Dermis that is thick and more adherent to underlying tissue is preferable.

Materials and Methods: a 15 year old victim of a motor vehicle accident was admitted with a femur, tibia, and fibula fracture and severe crush injury of the foot. The patient underwent ORIF of the fractures and multiple debridements of the foot. Finally, the patient underwent a modified chopart amputation of his foot. The wound was noted to be infected with pseudomonas aeroginosa and after multiple debridements was covered with a free extended vertical trapezius myocutaneous free flap. The superior fibers of the trapezius muscle and its innervation was spared in the harvest to preserve shoulder elevation.

Results: the patient underwent the procedure without complication. A 35 cm flap was harvested with a pedicle length of 8 cm. No flap necrosis was noted in the postoperative follow-up period. Post op day 2 the distal part of the flap was elevated due to the presence of greenish discharge. Dressing changes with acetic acid were performed for 4 days. The flap was then re-inset post op day 10 and the patient went on to heal. No donor site morbidity was noted and the patient is able to elevate his shoulder without difficulty.

Conclusion: In this paper we report the second case in the literature of a trapezius muscle flap used as a free tissue transfer and the first for reconstruction of the foot. The indications for the use of this flap are limited. However, when a very long flap is needed that has a thick dermis and a good blood supply, this flap is ideal.