Abstract Objective To observe the clinical effect of three different flaps in repairing skin defects after open ankle fracture and dislocation.Methods The clinical data of 51 patients with open ankle fracture and dislocation treated in our department from January 2015 to February 2021 were studied retrospectively. According to the different donor areas selected for repair, the flaps were divided into 29 cases of perforating artery perforator flap (PAPF), 15 cases of sural neurocutaneous flap (SNCF) and 7 cases of anterolateral thick flaps (ALTF). The operation time, flap area, vascular crisis, healing and complications were observed. The fracture healing time, American Orthopaedic Foot and Ankle Society (AOFAS) and flap sensory function were followed up 3 and 6 months after operation.Results (1) 48 cases survived and 3 cases had partial necrosis, including 1 case in PAPF group (3.44%) and 2 cases in SNCF group (13.33%). Venous crisis occurred in 5 cases in PAPF group, 3 cases in SNCF group and 1 case in ALTF group within 48 hours after operation. Among them, 6 cases recovered after removing the pedicle suture, 2 cases further removed the suture around the flap, reduced the tension, and recovered after continuous skin edge bleeding. 1 case in ALTF group reappeared the venous anastomosis. (2) The average rotation angle of the flap in the PAPF group was 129.64±11.39°, and SNCF group was 123.08±10.86°,there was no significant difference(P > 0.05). The operation time and intraoperative bleeding in ALTF group were significantly higher than those in PAPF group and SNCF group (P < 0.001). There was no significant difference in flap area, healing and hospital stay among the three groups (P > 0.05). There were 2 cases (28.57%) of postoperative deep venous thrombosis in ALTF group, which was significantly higher than that in PAPF group and SNCF group (P < 0.001). (3) The patients were followed up for 12-18 months, with an average of 14.67 ± 1.96 months. The fracture healing time was 3 ~ 6 months, with an average of 4.83 ± 1.05 months, there was no nonunion. At 6 months, 8 months and the last follow-up, there was no significant difference in AOFAS score among the three groups (P > 0.05). At the last follow-up, the blood supply of the flap was good and there was no secondary scar contracture. The sensory function grade of PAPF group and SNCF group was better than that of ALTF group (P < 0.05).Conclusion Perforating artery perforator flap or reverse sural nerve flap with peroneal artery to repair open ankle fracture and dislocation has less complications and high satisfaction with the recovery of flap appearance and sensory function.