A 65-year-old man sustained a severe crushing injury to his left lower leg while working at a manufacturing factory. Following radical debridement, massive soft tissue defects were observed. Therefore, we decided to achieve soft tissue coverage using an extended ALTP free flap (25 x 14 cm2) and designed the flap on the contralateral thigh based on a template reflecting the size and shape of the defect (Figure 7A). During the harvest of the ALTP flap, we found one perforator from the DB-LCFA and the other from the TB-LCFA. A turbocharging procedure was required to obtain stable blood circulation in the flap. After obtaining information on the future course, we estimated the length of the ALTP flap pedicle through recipient vessel dissection. We then attempted to postulate the optimal length of the TB-LCFA and the best side branch of the DB-LCFA for the turbocharging procedure; however, this was too difficult to confirm because the complexity of the recipient's wound hindered exact evaluation. Therefore, we planned to perform a turbocharging procedure at the recipient site. The designed flap was harvested with long TB-LCFA and DB-LCFA with multiple side branches (Figures 7B,C) and transferred to the recipient site. The DB-LCFA of the flap was connected to the anterior tibial vessels in advance. We then found a side branch of the DB-LCFA that could be anastomosed to the TB-LCFA without tension. Therefore, the turbocharging procedure was successfully executed (Figures 7D,E), and adequate coverage of soft tissue defects was obtained. The flap survived without any postoperative complication (Figure 7F). However, the patient died one month after the surgery because of sepsis caused by aspiration pneumonia (not related to reconstructive surgery).