Abstract: Objective　To investigate the clinical effect of the modified mid-low propeller perforator flap of the peroneal artery in repairing skin and soft tissue defects around the ankle.　Methods　From September 2016 to January 2018, 18 patients with soft-tissue defects around the ankle underwent the modified mid-low propeller perforator flap of the peroneal artery to repair the wound. Preoperative detection and localization of the perforator were achieved using the portable Doppler, and the modified propeller flap was harvested. The main trunk of the peroneal artery was used as the axis of the flap. The perforator was used as the boundary to divide the flap into a large head (large paddle) and a smaller head (small paddle). The distance from the perforator to the wound was used as the length of the large paddle. The width of the flap was 1/2~2/3 of the length of the large paddle, and the length-width ratio of the large paddle was not more than 2:3. Large heads were used to repair soft tissue defects around ankle and small heads were used to repair wounds resulted from the harvest of large heads. The sural nerve and the small saphenous vein were preserved during operation. The area of the soft tissue defects around the ankle ranged from 3.0 cm×3.0 cm to 10.0 cm×4.5 cm. And the area of the modified mid-low propeller perforator flap was 5.0 cm×3.0 cm to 23.0 cm×5.0 cm. The clinical effect was evaluated by observing the shape and function of the recipient site and donor site.　Results  All 18 cases survived successfully in the first stage of the flap, and 16 cases were followed up. The follow-up time ranged from 7 to 21 months (mean 13 months). The flap was good in luster and texture. The two-point discrimination perception ranged from 7 to 11 mm. The appearance of the affected area was satisfactory. The patients' shoes and ambulation were not affected. The lateral sensation of foot and foot reflex were normal. The AOFAS score of the affected foot was 92 to 97, with an average of 94.　Conclusions　The modified mid-low peroneal propeller perforator flap is an ideal way to repair the skin and soft-tissue defects around the ankle. It can avoid the distal necrosis of the flap and protect the donor area as much as possible.

Key words: Peroneal artery, 　Perforator flap, 　Soft tissue defect, 　Wound repair, 　Ankle