We describe our experience with the use of distally based superficial sural flap for cover of a defect in the lower leg and foot in a 3-year-old patient. The flap was used as a fasciocutaneous flap and resulted in quick, straightforward closure of a large soft tissue defect with prompt recovery. The patient was discharged home within 5 days of surgery. The advantages of this flap are: easy and quick dissection, low morbidity of donor site and preservation of major arteries of the leg. It allowed us to avoid the technical challenges associated with microsurgery in a small child and the postoperative care was simple, obviating the need for postoperative sedation, ICU care or close monitoring. Two dressing changes were performed in the hospital before the patient was allowed to return home. We present the experience with this case to illustrate what we consider an excellent aIternative to free flaps for covering lower leg and foot defects in small children. The use of reverse sural flap in small children is technically easy to perform, provides very good flap and donor site results and simplifies the postoperative care.