The aim of this report is to show the results obtained from using the neural-island flap to cover the soft tissue defects of the foot and ankle. This is the first report of the neural-island flap series since the introduction of this flap to the literature in 2003. Between 2002 and 2009 "neural-island flap'' was used to treat 20 patients of various lesions on the foot and ankle. All of the patients had serious soft tissue defects that compromised tendons, bones, or joints. In 16 patients, the tissue defects were completely and successfully covered with an uncomplicated postoperative course. In 4 patients the flaps presented venous congestion and intermittent bleeding and leech application was performed for 2 to 3 days postoperatively. Two of these flaps healed completely without any flap loss. In one patient because the partial flap necrosis occurred in distal one-fourth of the flap, skin grafting was performed after 1 week of vacuum-assisted closure application. Total flap necrosis occurred in only one patient who was suffering from Buerger disease. The authors conclude that the neural-island flap is a highly versatile, easy, and reproducible flap that avoids the use of complicated and risky reconstruction options. It can be considered as an alternative reconstruction option particularly in problematic cases that are not suitable for local or free tissue transfers.