Postoperative finding after 3 months. 

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... 45-year-old male was admitted to the emergency room with painful swelling of the right lower leg following a traf- fic accident. After radiologic evaluation including lower extremity computed tomography (CT) angiography and X-ray, right popliteal artery occlusion and right proximal tibia fracture were confirmed (Figure 1). Emergent popliteal artery revascularization was performed and intact distal flow in the anastomosis site was shown in the postoperative CT angiography (Figure 2). But later, some symptoms such as severe pain, swelling, and pulseless dorsalis pedis, strongly indicating compartment syndrome, developed. Hence, emer- gent fasciotomy was performed on both sides of the lower leg, and the symptoms almost subsided except for foot drop due to common peroneal nerve injury. But a pressure sore developed on the right heel area, and it was aggravated by continuous compression caused by the lower leg splint. For coverage of the soft tissue defect, a pedicled propeller flap was planned using the peroneal artery (PA) perforator as the first choice or the posterior tibial artery (PTA) perforator as an alternative for preparation of improper PA perforator ( Figure 3). In the preoperative vascular assessment, the pulse of the perforator was intact; but we could not rule out the possibility of vascular injury, and hence, the first incision was made on the central portion above the Achilles tendon for preparing an improper PA perforator state. Through the incision, subfascial dissection under microscope magnifica- tion was performed to identify all PA perforators around the defect. But the PA perforator was insufficient for propeller flap coverage based on its pulsatility and caliber; therefore, another dissection was performed through the first incision to identify the PTA perforators. After sufficient dissection around the defect, we found a proper septocutaneous perfora- tor with a good pulse and sufficient caliber for pedicle, which is located 4 cm above the tip of the medial malleolus between the flexor digitorum longus and soleus (Figure 4). Then, the perforator was freed from any surrounding tissue and dis- sected as long as possible in order to achieve an adequate length of the pedicle and prevent torsion. After 180° clock- wise rotation of the flap to its new position, the pedicle was checked for torsion, traction, or kinking. Then, closure was obtained without tension and a split thickness skin graft was performed for a 3 × 3 cm sized defect in the proximal portion of the flap ( Figure 5). Postoperatively, the flap remained viable and the patient's postoperative course was uneventful except for distal ecchymosis and temporary venous conges- tion. Furthermore, there were no notable complications such as arterial or venous ...