Fig. 6

A typical case of a 52-year male. A After debridement, large soft tissue defects on the medial and lateral sides of the right calf existed, accompanied by tendon and bone exposure. B The location of the emerging point (P1-P3) came out from the deep fascia and the real-time perforators mapping were depicted on the anterolateral skin of the left thigh according to the prepared CTA images. Meantime, the pulse point of perforators (B1-B2) was also marked on the skin surface using handheld Doppler ultrasound. During operation, the lateral edge of the flap was cut up, and the cutaneous branches around the emerging points were carefully separated. It should be noticed that the emerging points of the perforators were in accordance with the preoperative marked locations determined by AR, while the points located by ultrasound were far away from the perforators. Finally, a double-foliate ALTP flap containing three perforators was obtained. C The damaged calf was reconstructed by the ALTP flap