In the treatment and management of severe wounds, microsurgical repair remains the gold standard. However, it is difficult to transfer free tissue from a Tanzanian perspective due to donor site morbidity, longer operational times, bulky forms, recipient vessel stress, sophisticated surgical expertise, and high costs of the equipment. Meanwhile, the reverse sural flap has been considered as the ultimate tissue restoration technique. This study reviews a case of a 35-year-old man who was admitted at Mbeya Zonal Referral Hospital in the Department of Orthopaedics, Trauma, and Neurosurgery in Mbeya, Tanzania. The patient had a 9-day injury to the rear of his right ankle due to a cut he suffered after tripping over a toilet seat in the washroom. After the diagnosis, the plan involved surgical debridement, tendon repair, and reverse sural flap rotation. Despite the difficult working environment requiring advanced learning experience, our patient fully recovered after 3 weeks. Proving that reverse sural flap is one of the few available possibilities in the protection of vital structures such as bone or tendons, in the distal areas of the leg, ankle, and foot especially when the medical treatment facility lacks a strong microsurgery team and equipment.