We describe our experience with, and evaluate the reliability of, the lateral supramalleolar flap that was used in 20 patients for reconstruction of the distal leg and foot. There were 14 men and six women, age range 20-83 years. Nine were diabetic. The causes of the skin defects included trauma, diabetic ulcer, and deep burn. Sites of defects were the lower leg, the Achilles tendon, the dorsal and lateral aspect of the foot, and the ankle. Nineteen flaps survived and provided satisfactory coverage of the defect. Four flaps showed partial necrosis and required revision. We think that the lateral supramalleolar flap is a good way to reconstruct soft tissue defects of the lower extremity. Based on a secondary vascular axis, it has a large skin paddle and a wide rotation arc that reaches the distal areas of the foot.