Fig. 2

A, B A 57-year-old man (case number 5 in PPF group) on haemodialysis with an ankle dislocation fracture with soft tissue necrosis. Simultaneous osteosynthesis and soft tissue reconstruction was planned. C The perforator-based propeller flap (asterisk) using the posterior tibial artery perforator was elevated, and a split-thickness skin graft was inserted at the donor site. D Congestive partial necrosis at the tip of the flap and exposure of the implant at the medial malleolus were observed. Twenty-five days after insertion of the propeller flap, soft tissue reconstruction using an anterolateral thigh free flap was performed using the tibialis posterior artery as the recipient vessel. E The findings at 6 months after surgery. The soft tissue defect was completely covered with the anterolateral thigh free flap (hashmark). F X-rays at 6 months after surgery showed bone union. Calcification (arrowhead) can be seen along the course of both ATA and PTA