Abstract: The distally based sural neurocutaneous flap has been used for coverage of defects in foot and ankle for years. Conventional flaps do not extend to the upper third of the leg, which limits its application. The current study presents results using extended distally based sural neurocutaneous flaps for reconstruction of extensive soft tissue defects of the foot and ankle in 21 patients. All injuries occurred from 2001 to 2011 as a result of a traumatic event. Follow-up of 21 patients ranged from 7 months to 5 years after surgery. All 21 flaps survived successfully. The largest flap used measured 26 × 15 cm. Complications included 1 distal marginal necrosis and 2 slight venous congestions. The extended distally based sural neurocutaneous flap is a good alternative for extensive soft tissue defects of foot and ankle. The operative techniques with several simple modifications in harvesting the flaps are easy to handle and will not prolong the operation time.