Background: Reconstruction of lower leg represents a challenge task for plastic surgeons. Although microsurgical flaps have been the golden choice for this reconstruction, many hospitals do not have equipment or microsurgical staff trained for this type of procedure. Aim: The objective of the current study is to evaluate of clinic applicability and functional outcome results of medial hemisoleus muscle as a reconstructive flap modality in lower third leg soft tissue defect. This includes clinical study comparison between two surgical modalities of hemisoleus muscle Hap  elevation. Methodology: This study was conducted in Plastic Surgery Department, Aswan University Hospital from May 2017 to August 2018. It was a descriptive study including 30 patients (23 males and 7 females with the age ranging between 29 and 51 years). Results: Our study confirmed this fact as preservation of lateral portion is suitable for planter flexion with gastrocnemius muscle and medial hemisoleus muscle flap showing long arc of rotation especially distally based posterior tibial artery medial hemisoleus muscle flap has long arc of rotation cover up to heal defect.  Conclusion: Medial hemisoleus muscle flap is a reliable option for the reconstruction of soft tissue defects of lower leg based on minor pedicle or reversed flow based on posterior tibial artery. Careful flap dissection with preservation of as many perforators as possible is the key to success.