Background: Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. Case Report: The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient’s progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. Results: The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient’s feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient’s ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. Conclusion: This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management.

Purpose: Coronal‐plane classifications such as the Coronal Plane Alignment of the Knee (CPAK) classification support individualized total knee arthroplasty (TKA) planning but do not account for sagittal‐plane morphology, particularly the posterior tibial slope (PTS). This study aimed to determine whether unsupervised machine learning (k‐means clustering) could identify naturally occurring PTS phenotypes in osteoarthritic knees and to evaluate their association with CPAK classification and joint line obliquity (JLO). Methods: This retrospective radiographic cohort study included 3337 osteoarthritic knees from 1746 patients. PTS was measured on lateral knee radiographs in all 3337 knees, using the posterior tibial cortex and the medial tibial plateau as reference lines. Full‐length standing radiographs were available for 464 knees; in these knees, the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA) were measured to calculate the arithmetic hip–knee–ankle angle (aHKA) and JLO, and each knee was classified according to CPAK. K‐means clustering was used to identify PTS subgroups without predefined thresholds, and cluster validity was assessed using the elbow method and silhouette analysis. Associations between PTS clusters, CPAK phenotypes and radiographic parameters were analysed using the χ ² test, adjusted standardized residuals, Fisher's exact test and correlation analysis. Results: The median PTS was 5.6° (interquartile range 3.4°–7.7°). K‐means clustering identified two PTS clusters: a shallow‐slope cluster centred at 3.56°, comprising 55.91% of the knees and a steep‐slope cluster centred at 8.52°, comprising 44.09%. No individual CPAK phenotype was significantly overrepresented within either cluster. When phenotypes were grouped according to joint line orientation, however, apex‐distal phenotypes (I–III) were more frequently assigned to the steep‐slope cluster, whereas apex‐neutral phenotypes (IV–VI) were more frequently assigned to the shallow‐slope cluster. JLO was significantly higher in the shallow‐slope cluster and PTS showed a modest inverse correlation with JLO. Conclusions: Unsupervised k‐means clustering identified two distinct sagittal PTS phenotypes in osteoarthritic knees. PTS varied largely independently of the individual CPAK phenotypes, although an association with JLO was observed. Sagittal morphology may therefore provide complementary information beyond coronal alignment classifications for the individualized planning of knee surgery. Level of Evidence: Level IV.

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator—a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical.