Abstract: Objective To explore the clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar skin and soft tissue defect of ankle. Methods From September 2015 to September 2017, 10 patients with lacunar skin and soft tissue defects of ankle were hospitalized in our unit, including 7 males and 3 females, aged 17-62 years, 8 traffic accident injuries and 2 heavy body pressure injuries. After debridement, the wound area ranged from 7 cm×4 cm to 15 cm×9 cm, and the lacunar area ranged from 3.0 cm×2.0 cm×1.0 cm to 7.0 cm×4.0 cm×2.0 cm. The defect was repaired with island composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel and partial gastrocnemius muscle at stage Ⅰ. The area of flaps ranged from 8 cm×5 cm to 16 cm×10 cm, and the area of gastrocnemius muscle flaps ranged from 4 cm×3 cm to 8 cm×5 cm. The donor site was repaired with ipsilateral thigh intermediate split-thickness skin graft or sutured directly. The location of vascular pedicle, survival of tissue flap, follow-up, and occurrence of complications were recorded. Results The vascular pedicle of this group of cases was located 5-15 cm above the lateral malleolus. The tissue flaps of 10 patients survived completely after operation at stage Ⅰ. Follow-up for 1-12 months showed that the area repaired with tissue flaps had good color, blood supply, and texture, without ulceration, and recovered different degrees of pain sensation and deep tactile sensation, and no short-term or long-term complications occurred. Conclusions The double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle has good blood supply, which can effectively fill the invalid space in repairing lacunar skin and soft tissue defect of ankle, with good effect after operation, and it is worthy of clinical application.