Objective To compare the effect of distally based perforator-plus sural fasciocutaneous flap for soft tissue reconstruction of the lower leg in pediatric and adult populations.Methods Data of 165 patients treated with distally based perforator-plus sural fasciocutaneous flap between April 2001 and February 2011 were retrospectively reviewed.There were 125 males and 40 females,at age range of 3-78 years.The patients were divided into pediatric group (＜ 14 years,n =50) and adult group (≥ 17 years,n =115) according to the age.The two groups were compared in terms of flap-viability-related complications (partial necrosis,marginal necrosis and overall complication rate) and their potential risk factors (sex,location of defect,causes of defect,pivot point site and top-edge location).For the patients followed at least 12 months,the reconstruction outcomes,donor-site morbidities(hypertrophic scar,pruritus,pigmentation,numbness of skin graft area and paresthesia of skin graft area),and swelling of the limb were compared between the groups.Results All patients were followed up for 2 weeks to 72 months.Partial necrosis of the flap,marginal necrosis of the flap,and overall complications in pediatric group accounted for 14％,4％ and 18％ respectively,higher than 11.3％,1.7％ and 13.0％ in adult group,but the differences were insignificant (P ＞ 0.05).Sex ratio,pivot point site and top-edge location were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented a significantly lower proportion of pretibial defects,but significantly higher proportions of the defects over the achilles tendon and heel (P ＜ 0.05).A significantly higher proportion of spoke injury and lower proportions of tamp injury and sports injury were observed in pediatric group than in adult group (P ＜0.05).Reconstruction outcomes were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented significantly higher incidences of hypertrophic scar and pruritus at the donor site,but a significantly lower incidence of limb swelling (P ＜ 0.05).Conclusion Reliability and repair effect of the distally based perforator-plus sural fasciocutaneous flap are similar between pediatrics and adults,while the pediatrics are more likely to have hypertrophic scar and pruritus at the flap donor site.