Abstract: Objective To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle. Methods Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm×4 cm to 23 cm×10 cm. Patients were treated with debridement and vacuum sealing drainage (VSD) after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroneal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm×5 cm to 25 cm×12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side. Results After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well. Conclusions Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.