Objective To investigate the feasibility of interventional CT angiography （CTA） with three-dimensional reconstruction for guiding the use of posterior tibial artery perforator flaps in wound repair. Methods A retrospective investigation of 10 patients with lower leg soft tissue defects was conducted between February 2024 and February 2025. The flap was designed using interventional CTA three-dimensional reconstruction， which took into account the CT scan results， perforator position， and wound size. A posterior tibial artery perforator flap was utilized to close the wound. Results All patients in this study had noticeable posterior tibial artery perforators， and the intraoperative anatomy of 10 cases matched the preoperative placement. Nine flaps survived. One flap had necrosis at the edge， but it healed after dressing change therapy. Conclusion The application of interventional CTA three-dimensional reconstruction improves preoperative localization of the posterior tibial artery perforator， facilitates assessment of perforator vessel location， course， and blood supply， and guides preoperative flap design. The posterior tibial artery perforator flap with interventional CTA three-dimensional reconstruction achieves good results in repairing lower leg soft tissue defects.

Posterior tibial artery perforator flap, Wound repair, Soft tissue defect