Background: Soft tissue defects of the ankle region continue to present a complex reconstructive challenge to the reconstructive surgeon. Many flaps have been used to rebuild these defects, and each flap has its own merits and drawbacks. This randomized controlled study was designed to compare between the peroneal artery perforator flap and the posterior tibial artery perforator flap for the ankle region reconstruction and finding out advantages and disadvantages of each flap.Methods: Between July 2020 and April 2022, 22 patients presented with soft tissue defects around the ankle with exposed vital structures as bones and tendons, who were categorized into two equal groups group 1: The peroneal artery perforator flap group (11 patients) and group 2: The posterior tibial artery perforator flap group (11 patients). Post-operative complications were the primary comparative parameters.Results: In total 22 patients with tissue defects around the ankle region were operated with either the peroneal artery perforator flap and the posterior tibial artery perforator flap 11 cases in each group, the post-operative flap complications as total flap loss and distal flap necrosis were (18.2%), (27.3%) receptively in the peroneal group and (27.3%), (36.4%) in the posterior tibial group and the mean time of flap elevation was longer in the posterior tibial group (106.82min) compared to the peroneal group with (64.55min). Conclusion:The peroneal artery perforator flap is better elevated as pedicled while the posterior tibial artery perforator flap better elevated as propeller.