BACKGROUND: Repair of both simple and complex defects in the distal lower leg continues to be a challenging task for reconstructive surgeons because of the local paucity of soft tissue available for transfer. The popular neurocutaneous flap, introduced by Masquelet et al in 1992, has provided a reliable and less technically demanding method for resurfacing defects of the lower leg. We herein present our experience with the versatile design of the distally based saphenous neurocutaneous perforator f lap to provide coverage of complex posttraumatic lower leg defects by harvesting multiple tissue compo-nents in various combinations. PATIENTS AND METHODS: Our series comprised 14 patients (11 men, 3 women; average age, 40.4 years; range, 22-58 years) who underwent an average follow-up period of 19.2 months (range, 9-25 months) (Table 1). The distal pivot point was kept at 5 to 7 cm above the tip of the medial malleolus, pre-serving the distal-most perforator, and 4 flaps were taken with massive sub-cutaneous tissue to obliterate the dead space. RESULTS: The procedure was uneventful in 13 patients. Slight venous con-gestion was noted in 1 patient, and secondary healing was achieved by con-servative treatment. CONCLUSIONS: The distally based saphenous neurocutaneous perforator flap is an excellent alternative for skin resurfacing of the distal lower leg, with sat-isfactory functional and aesthetic outcomes.