Background: Distal leg and ankle defects are challenging to reconstruct because of limited local tissue availability and regional vascularity. Posterior tibial artery pedicled perforator flaps provide vascularized coverage while preserving the main arterial axis.
Methods: This prospective case series included 12 consecutive patients undergoing posterior tibial artery pedicled perforator flap reconstruction between January 2022 and December 2024. Patient characteristics, defect details, operative outcomes, complications, flap survival, and functional recovery were assessed.
Results: The mean age was 36.8 years (range, 18–62), and trauma accounted for 75% of defects. Complete flap survival occurred in 11 patients (91.7%). One patient developed partial distal necrosis involving less than 15% of the flap, which healed with conservative dressings. Early venous congestion occurred in two patients and resolved with limb elevation and suture release. No total flap loss occurred.
Conclusion: Posterior tibial artery pedicled perforator flaps are a feasible option for selected distal leg and ankle defects. Accurate perforator localization, tension-free inset, appropriate patient selection, and close postoperative monitoring are essential.

Keywords: Perforator flap; lower limb reconstruction; pedicled flap; propeller flap.