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The management of soft-tissue defects in the distal third of the lower leg and foot remains disputed. In this article, we describe a long-term follow-up research study on the clinical results and complications of using this flap for the reconstruction of soft-tissue defects around the lower leg and foot.Between 2006 and 2008, 70 patients with soft-tissue defects around the lower leg and foot were treated with distally based saphenous neurocutaneous perforator flaps. The mean age of patients was 46.0 years (range, 22 to 70 years). An end point survey was performed after flap coverage; the mean follow-up was 54.2 months (range, 40 to 68 months), and response rate was 92.9% (65/70). A sensory morbidity was measured with a static two-point discrimination test and Semmes-Weinstein monofilament test.A total of 58 flaps were survived completely, 6 flaps developed partial necrosis, and 1 experienced total failure. No severe venous congestion was observed and the skin grafts in the donor sites survived entirely. Sensitivity tests have shown an acceptable sensory recovery at the skin-grafted donor site and on the flap.Distally based saphenous neurocutaneous flap is a reliable and safe method for reconstruction of the defects around the lower leg and foot, with a lower sensorial morbidity.