Fig. 3

A A-65-year-old man with an open distal tibial fracture. B, C After osteosynthesis with an anterolateral plate, a 3 × 3 cm soft tissue defect with plate exposure remained on the anterior surface of the tibia. D Three weeks after osteosynthesis, soft tissue reconstruction was performed using a tibialis posterior perforator-based propeller flap (asterisk). The flap survived intact without complications such as congestion, but osteomyelitis occurred at 5 months after insertion of the propeller flap. Debridement and re-osteosynthesis with an autogenous iliac bone graft were performed. E X-rays 1 year after re-osteosynthesis. Implant breakage caused by infectious pseudoarthrosis was confirmed. F Bone reconstruction was performed using a contralateral free vascularized fibula bone graft (hashmark). G X-rays 2 years after insertion of the vascularized bone graft showed complete bone union