Objective To investigate the anatomy and clinical effect of the anterolateral skin flap in the lower leg and the reversed superficial pereneal neuracutaneous island flap. Methods Seven cases of hand skin defect were treated with anterolateral skin flap in the lower leg with vascular anastomosis. 7 cases of ankle soft tissue loss were repaired with reversed superficial peroneal neurocutaneous island flap. 4 cases of the tissue defects in the middle and proximal parts of the leg and 13 cases of the tissue defects in the middle and distal parts of the leg were repaired with sequential superficial peroneal artery island flap and combined flap of super-ficial peroneal artery island flap and superficial peroneal neurocutaneous island flap respectively. Results Seven cases of the anterolateral skin flap in the lower leg with vascular anastomosis, 4 cases of the sequential superficial peroneal artery island flap and 13 cases of the combined flap of superficial peroneal artery island flap and superficial peroneal neurocutaneous island flap were survived.Becanse of vein drainage disturbance which led to partial necrosis of flap, one case of the reversed superficial peroneal neurocutaneous island flap was de-layed healing with epluehage and skin grafting. Conclusion The anterolateral skin flap in the lower leg and the reversed superficial peroneal neurocutaneous island flap compensate each other anatomically. The operation based on the anatomy enlarges the size of the flap and extends the scope of reconstruction. Key words: Anterotateral flap of lowerleg; Superficial peroneal nerve; Transplantation; Micro-surgery