The fasciocutaneous flap in the lower leg has been widely used since Pontén's 1981 report. The cutaneous artery running along the sural nerve—known as the superficial sural artery—has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch.The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve.We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.