When the superficial lateral sural artery was absent or was too small to be used, the SLSAP flap was converted to harvest a superficial medial sural artery perforator (SMSAP) flap during the operation. The incision was aptly extended toward the medial side, and blunt dissection was performed on the surface of the deep fascia to expose the superficial medial sural artery and its perforators. The flap location was adjusted based on the locations of the perforators.