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Background  The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients.    Method  This is a case report of a 24 years old male who had Gustillo and Anderson type IIIB injury involving the upper part of the distal 3 rd  and the middle 3 rd  of tibia. A reverse sural artery flap was raised without transecting the sural nerve to cover the distal part of the defect.    Result  The distal part of the exposed bone was covered with the reverse sural artery flap without loss of sensation at anytime to the lateral part of the foot.    Conclusion  The reverse sural artery flap can be raised to cover the upper portion of the distal leg without severing the sural nerve.

Sural nerve preservation in reverse sural artery fasciocutaneous flap-a case report