Objective To report the improved operative technique and clinical results of sural nerve nutritional vessel axial flap Methods Based on anatomical studies,the sural nerve nutritional vessel flap pedicle with the lowest perforating branch of the peroneal artery were performed to repair the soft tissue defects of the lower leg,the ankle and the foot Results The modified flaps were applied in 7 cases,all flaps survived completely The size of the flap ranged from 30 cm?10 cm to 23 cm?8 cm The length of pedicles were 1 6～3 0 cm The colour and texture of flaps were excellent,the outline and functional results were satisfactory after 6～12 months follow up Conclusions This new procedure can enlarge the survival and repairing area of the flap,it can also solve the distortion problem of fasciocutaneous pedicle The blood supply of this flap is reliable Flap elevation is easy and quick It is very useful in repairing large skin defects of the lower leg,the ankle and the foot