The lateral supramalleolar flap was used in 41 cases of distal third of the leg, foot, ankle, and heel skin defect reconstruction. The arterial blood supply was mixed in 33 cases and retrograde in 8 cases. The authors recommend raising a distal subcutaneous pedicle to avoid skin grafting over the tendons. In main cases of mixed blood supply, the superficial peroneal nerve could be spared. Eight venous congestions were observed, including 3 with partial flap necrosis. The plastic result was assessed as satisfactory in all but 2 patients. The cosmetic aspect was satisfactory in only 6 patients. Donor site morbidity was minimal, while cosmetic results were assessed as satisfactory in all but 2 patients. The main local alternative was the distally based sural flap, which is technically less demanding. Except for the distal coverage of the foot, indications for both flaps are similar. The distally based sural flap requires the sural nerve to be divided and does not cover as distally as the lateral supramalleolar flap.