Objective To investigate the selection of pedicled flaps and Achilles tendon reconstruction for grade Ⅲ spoke heel injuries in children.Methods Thirty-one children with grade Ⅲ spoke heel injuries in motorcycle accidents treated from January 2007 to June 2013 were reviewed retrospectively.There were 19 males and 12 females,aged of 3-12 years (mean,5.2 years).According to the injury time,systemic condition,and size and location of Achilles tendon defect,different surgical options were adopted.Soft tissue defect ranged in size from 8.0 cm × 4.5 cm-3.5 cm × 2.5 cm.Length of Achilles tendon defect was 1.5-4.4 cm.Time from injury to operation was 2 h-26 d (mean,4.4 d).Eighteen cases were reconstructed in one stage and the others in second stage.Sixteen cases received combined gastrocnemius musculocutaneous V-Y advancement flap repair and reconstruction of Achilles tendon insertion.Eleven cases underwent saphenous neurocutaneous vascular flap (7 cases) or posterior tibial artery perforator flap repair (4 cases) and reconstruction of Achilles tendon insertion.Four cases received sural neurocutaneous vascular flap (3 cases) or peroneal artery perforator flap repair (1 case) and reconstruction of Achilles tendon insertion.Flap conditions and complications were recorded.Ankle flexion-extension motion,gait and subjective symptoms were followed up.Results Postoperatively,3 cases presented partial necrosis of the flap end,and one case presented local infection of the Achilles tendon.Mean duration of follow-up was 13 months (range,6 months-4 years).Dorsiflexion of the ankle was limited at postoperative 6 months,and mean dorsiflexion was 95.4°.Dorsiflexion function of the ankle was improved over time,and mean dorsiflexion was 87.3°at postoperative 18 months.All acquired normal gait.Conclusion The pedicled flap plus vascular tendon or fascia result in satisfactory effect in treatment of grade Ⅲ spoke heel injuries in children.