The evolution of microsurgery and orthoplastics has expanded our ability as surgeons to manage complex lower extremity soft tissue defects. This evolution relies on the understanding of reconstructive surgical principles for problem solving and analyzing outcomes. The purpose of this review is to determine flap selection with a focus on reliability based on the outcomes of lower extremity free tissue transfer versus vascularized perforator pedicle flap transfer in lower limb reconstruction. A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the databases PubMed/MEDLINE. Data were compiled by reviewing the number of patients, age, comorbidities, complications, size and location of defect. Outcomes were analyzed by indicated soft tissue defect size, location and cause, as well as subsequent flap size, type, survival, durability and their functional results. Overall, 72 topic related studies from 2014-2017 were reviewed. Sixteen of the 72 met the final inclusion criteria. Patient study sizes from the included articles ranged from 7-428 cases. The current qualitative systematic review of flap transfer in the lower extremity has contributed a summary of reported outcomes in literature thus far. After analyzing existing evidence, our study found no significant differences between reconstructive options with a paucity of evidence to clearly recommend the ideal flap transfer for microsurgical reconstruction of lower extremity soft tissue defects.