The distally-based lesser saphenous-sural fasciocutaneous flap had become a mainstay in the reconstruction of the distal leg and the ankle.Many modifications of the reconstruction techniques were made to improve the viability of the flap and to meet a myriad of the reconstructive needs.However,the morbidity of the donor-site and the bulky flap of the recipient-site were always a problem.Herein,we presented a modified minimally invasive procedure to harvest the reverse sural adipofascial flap to cover the defects in the distal leg and the ankle,which meet both the functional and aesthetic needs of reconstruction.The adipofascial flap was elevated through two short incisions along the axis of the flap.It consisted of a sural nerve,a lesser saphenous vein,several accompanying arteries,partial fat and a deep fascia,excluding the skin and the underlying thin fat layer which are important components of the original reverse sural fasciocutaneous flap.We evaluated the data from the early 23 patients who were treated with the modified flaps.All the ?aps successfully survived and provided adequate coverage for the recipient-sites.The donor-sites were all closed primarily with no skin grafts,healed with better appearance.The patients were able to wear shoes and walk as they did before the injuries.They were all satisfied with the short scars.Compared with other flaps,this flap was thinner and able to provide an anatomic contour to the recipient-site,with shorter scars to the donor-site.In conclusion,the reverse sural adipofascial flap with a modified technique was a new,simple and reliable method for the aesthetic reconstruction of the soft-tissue defects in the distal leg and the ankle.