BackgroundThe distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. In the difficult area of defects in the lower leg and the ankle and heel region, it has a wide variety of indications, even in the vascularly compromised patients. It has the largest arc of rotation of all flaps that have been described in this region. The most important advantage is that it does not compromise a major artery. It is simple to dissect and has a low donor morbidity.MethodsWe reported our experience with this new flap in 15 cases and also described a new indication for the patients with neglected ruptures of the Achilles tendon.ResultsIn 13 patients, the flap was successfully transferred. In two cases, partial necrosis of the flap ensued, which healed with secondary intention.ConclusionThis flap deserves a high degree of interest in the reconstructive armamentarium of the trauma surgeon.