Background: Reconstruction  of middle  third soft tissue  defects  of the legs  have  been a challenge to the plastic surgeons. Patients and methods:  We report 20 cases in which the extended single stage distally based sural flap was used to reconstruct soft tissue defects at the middle third of the leg over 2 year period. Result:  Complications occurred in 4 patients (20%). Two patients suffered surgical site infections and another two experienced  distal partial flap necrosis but all flaps survived. We can conclude that the flap is a good option for reconstruction of middle third leg defects of the leg. It has constant and reliable blood supply without sacrifice neither major vessel nor nerve