Abstract: Objective To compare free perforator and pedicled perforator flaps in repair of soft tissue defects around the heel. Methods From January 2009 to December 2011,9 patients with soft tissue defects around the heel were treated in our center with perforator flaps.They were 5 men and 4 women,with an average age of 35.4 years (from 18 to 51 years).The concomitant injuries included Achilles tendon rupture or defect in 3 cases,calcaneus tubercle fracture or defect in 4 cases,and calcaneus osteomyelitis in one case.The defect sizes ranged from 4 cm × 1 cm to 17 cm × 9 cm.The perforator flaps ranged from 5 cm ×2 cm to 18 cm × 10 cm.There were 5 free perforator flaps (3 ones with the descending branch of the lateral circumflex femoral artery,one with the transverse branch of the lateral circumflex femoral artery and one with the thoracodorsal artery) and 4 pedicled perforator flaps (3 ones with the fibular artery and one with the posterior tibial artery).The concurrent Achilles tendon rupture was repaired and the calcaneus fracture reduced and internally fixated. Results The 9 patients were followed for 6 to 39 months (average,21months).All the flaps survived completely.One free perforator flap experienced postoperative vein congestion which was resolved after surgical exploration.One pedicled perforator flap had the problem of distal vein reflux but survived after continuous massage. The postoperative leg myodynamia reached level V in each case.Generally the free perforator flaps were thicker than the pedicled ones so that the patients with a thicker heel flap had a grinding feeling against the back collar of the shoe.All the patients regained a normal gait except one who had a cripple heel. Conclusions For small skin defects around the heel,pedicled perforator flaps may be the first choice while free perforator flaps are more suitable for large and wide skin defects around the heel.In any cases,the concurrent injuries to the Achilles tendon and the calcaneus should be repaired cautiously to minimize postoperative complications.