BACKGROUND: Managing large soft-tissue defects in the distal lower extremities remains challenging for orthopedic surgeons, particularly in elderly patients with comorbidities. This study evaluates the clinical outcomes of the reverse sural flap (RSF) for reconstructing soft-tissue defects in the distal leg, heel, foot, and ankle. METHODS: This prospective study was performed on 52 cases aged from 18 to 60 years old, with either post-traumatic or post-surgical soft tissue defects situated between the distal third leg and the mid-metatarsals of the foot and underwent RSF surgery. RESULTS: The mean hospital stay was 8.4 (± 3.24) days. All patients experienced the healing of their soft tissue coverage. During the follow-up, ten patients had complications: Ankle stiffness occurred in 2 (3.85%) patients, marginal necrosis in 2 (3.85%) patients, superficial infection occurred in 2 (3.85%) and delayed healing in 4 (7.69%) patients. CONCLUSION: The RSF is a reliable and practical option for reconstructing significant and distal soft tissue defects in the lower extremities, with acceptable complication rates and surgical durations. Complications were found in 10 cases in the form of ankle stiffness occurring in 2 (3.85%) patients
marginal necrosis occurred in 2 (3.85%), superficial infection occurred in 2 (3.85%) patients managed with dressing, debridement, delayed healing occurred in 4 (7.69%) patients and. The hospital stay's mean value (± SD) was 8.4 (± 3.24) days.