Objective:To evaluate the clinical results of using the free polyfoliate anterolateral thigh perforator flaps based on a single perforator in repair large soft tissue defects in extremities.Methods:Between March, 2014 and April, 2019, 9 patients with large soft tissue defects in extremities were repaired with the free polyfoliate anterolateral thigh perforator flaps based on a single perforator. One of the patients were repaired with bilateral free polyfoliate anterolateral thigh perforator flaps. Six defects on hand and wrist, 1 on forearm, 1 on shank and 1 on foot. The sizes of soft tissue defect ranged 5 cm×19 cm-17 cm×24 cm. All the wounds of donor site were closed primarily.Results:Seven flaps survived without vascular incidence. One flap developed artery crisis after surgery with the bilateral free polyfoliate anterolateral thigh perforator flaps. After emergency re-anastomosing, the flap survived successfully. Necrosis on one-leaf occurred in one flap, which was finally repaired by skin graft. The clinical results were satisfactory after 3-48 months of followed-up. The scars of the donor site were not obvious.Conclusion:The free polyfoliate anterolateral thigh perforator flaps can be designed with only one perforator. The flap can be changed into a variety of shapes based on the combination of the polyfoliate flaps in order to repair a large soft tissue defects in extremity. The polyfoliate flap has advantages of less donor site injury with a high survival rate.