Background: Open wound of the lower limb is one of the common health problems that have a significant economic and social burden. It has a risk of osteomyelitis of the underlying bone and even necrosis can occur. Objective: To evaluate the difference between the perforator-based island flaps and fasciocutaneous flaps in reconstruction of lower extremities regarding; functional, aesthetic outcome, size of the flap, degree of rotation, technical difficulties, percentage of flaps survival, flap loss, operative time and donor site morbidity. Patients and Methods: The study was conducted on 40 patients with soft tissue defects in lower extremities which were equally distributed into two groups. Group 1 consisted of 20 patients that were treated by perforator based island flap and group 2 that consisted of 20 patients treated by fasciocutaneous flap. Results: The two techniques had similar results when evaluated by the Likert scale. The results of both procedures had no significant statistical differences as regards any of the Likert score components namely, color, texture, appearance, and shape. The main finding of the current study was the comparable postoperative outcome for both techniques. The number of patients that had necrosis was 7 in perforate based island flap and 4 in fasciocutaneous flap which represented 35% and 20% respectively of each studied group and this was statistically insignificant. Conclusion: Any flap can be used as a perforator-based island flap in which the source vessel is completely preserved. Perforator flaps have multiple advantages over Fasciocutaneous flaps as allowing increased diversity and versatility in the design and composition of flaps.