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The arterial insufficiency is not rare in high risky patients for the reverse sural flap. Thus, we introduce a novel practical technique by performing intraoperative patency test to the sural artery to predetermine the arterial potential, to avoid a possible arterial insufficiency and to increase the reliability of the sural flap in these patients. We succesfully applied the reverse sural flap to seven risky patients with crushing injury, mine explosion, and diabetes, in whom the sural artery patency test was positive. The flap size varied from 8 3 5 cm to 16 3 10 cm. The major defect localization was the heel with/without sole. All flaps survived uneventfully with good contours and durabilities. The sural artery patency test obtain us to decide to safely raise the sural flap or not, and to predict the outcomes of the operative procedure in critical wounds associated with poor arterial supply.