The proximally based sural artery flap presents distinct advantages in reconstruction of knee and lower thigh defects including thin sensate flap, reduced donor-site morbidity with good aesthetic outcome. However there are few reports in the literature regarding this flap. This study presents our experience with use of this flap in 37 patients. A retrospective study was performed over a 6-year period (from January 2003 to October 2008) using proximally based islanded sural artery flap for the lower thigh, knee, and upper leg defects following tumor excision defects. There were no complete failures in the series with only one flap requiring additional bipedicled flap for the necrosis of distal margin. All donor sites were closed with split thickness skin graft, with skin paddle sizes ranging up to 23 x 10.5 cm. All patients achieved a good final outcome. The authors found the proximally based islanded sural artery flap to be a simple and reproducible technique to perform and have greater reach up to the lower thigh. It provides thin pliable skin with minimal compromise to either appearance or function. The flap is suitable in the regional reconstruction around the knee as a pedicled flap.