Aim of the study is to show the alternatives in the use of perforator flaps to cover soft tissue defects of the lower 1/3 of the leg and to clarify some technical points in the flap dissection . Introduction . The advent of perforator flaps was a breakthrough in the surgical treatment of soft tissue defects in difficult areas as it is the distal tibia , the malleoli and the posterior heel . The initial use of the fasciocutaneous flaps by Ponten and the description and refinement of several flaps with proximal or distal base enriched the armamentarium of the reconstructive plastic surgeon facing such difficult problems . Materials and methods . During the last 10 years , 1992 – 2001 perforator flaps have been used in 87 patients presenting soft tissue defects of the lower leg . Fifty three patients were males (60,9%) and 34 females (39,1%) with ages varying from 18 to 84 years old . In 45 cases a distally based perforator flap was used as a fasiocutaneous (island or not) or fasciosubcutaneous flap . Results . In a majority of cases 62 (71,26%) the postoperative period was uneventful , although we have experienced some complications , such as partial necrosis of the flap (especially in the distally based flaps) and infection . Discussion . Perforators flaps offered a solution in covering areas in the distal leg , the malleoli and the heel . One or two staged reconstruction with proximally or distally based flaps reduced the indications for microsurgical transfers and have proven several advantages such as conservation of the vascular axes of the leg , flexible pedicle , no risk from microsurgical anastomoses , reliability and easy dissection . A venous congestion for the first 3-4 postoperative days can be anticipated with the inclusion in the base of the flap as many perforators as possible or the use sometimes of leaches . In cases of infected bone the indication is brought rather to a muscular flap instead of a perforator flap . Conclusion . Flaps based on perforator branches of the vascular axes of the leg can solve problems of soft tissue defects in the distal leg , maleolar region and posterior heel showing several advantages over other reconstructive procedures .