Abstract: Objective：To investigate the reconstructive effect of soft tissue defect of Foremidfoot by the lower lateral supramalleolar reversed island flap with the wellknown branch vessel of the ankle.Methods：From January 2017 to August 2019, using anterior malleolus artery and Lateral iliac artery alone or combined, and according to the wound repair needs, and the flap rotation point was anatomied to the source vessel root, and Protect the vascular pedicle and the tissue integrity around its fascia, and the longest vascular pedicle was 12cm, 16 Foremidfoot soft tissue defect were repaired by lateral supramalleolar reversed island flap. The area of the wound ranged from 3.0cm×5.0cm to 8.0cm×13.0cm, and the defects on the donor sites were sutured directly or reduced or closed with a mediumthickness skin.Results：14 flaps were survival without infection and vascular crisis. One case had partial necrosis of the distal superficial tissue, and the Wound healed after dressing change. One case had venous reflux dysfunction blister at the distal flap, and the flap survived after the suture removal timely. The15 patients were followed up from 6 to15 months ,and one patient failed to follow up. 4 flaps of the obese patients had Flap thinning surgery. The remaining cases, the appearance of the flaps were good, without pigmentation, and some sensations were restored. Soft tissue was adhesion in the donor sites where were closed with a mediumthickness skin, but the ankle tendon sliding was not affected, and the functionwas restored satisfaction.Conclusion：Using anterior malleolus artery and Lateral iliac artery alone or combined, the rotation point of the lateral supramalleolar reversed island flap could move lower significantly.

Key words: lateral supramalleolar flap, low rotation, point wellknown blood vessels around the ankle, foremidfoot soft tissue defect