The usefulness of a reversed hemisoleus muscle flap as a local reconstructive option for soft-tissue coverage of an open tibial wound in the lower third of the leg has never been acknowledged. Over the past 2 years, 8 patients underwent soft-tissue reconstruction of an open tibial wound (3 x 3 to 10 x 6 cm) in the lower third of the leg with the reversed medial hemisoleus muscle flap modified by the author. The flap was dissected with attention to preserve several critical perforators from the posterior tibial vessels to the flap as possible while allowing adequate turnover of the flap to cover the exposed tibia or hardware. There was no total flap loss, and limb salvage was achieved in all patients. Only 2 patients developed insignificant distal flap necrosis, and they were treated subsequently with debridement and flap readvancement. All patients had reliable healing of their tibial wounds, with good reconstructive and cosmetic outcomes of their flap reconstructions during follow-up. Therefore, the author believes that the reversed medial hemisoleus muscle flap can be a good choice for soft-tissue coverage of a sizable open tibial wound in the lower third of the leg and may be used successfully to replace free tissue transfer in selected patients.