Objective To investigate the clinical application of reverse island flap of sural nerve nutrient vessels in the repair of skin and soft tissue defects of foot and ankle. Methods From January 2022 to January 2023, 50 patients with foot and ankle skin and soft tissue defects admitted to our hospital were selected as the research objects. According to the random number table method, they were divided into control group and study group, with 25 patients in each group. The control group was given cross-leg flap transplantation, and the study group was gi ven retrograde island flap repair of sural nerve nutrient vessel s. The flap recovery, surgical indicators and satisfaction were compared between the two groups. Results The excellent and good rate of flap recovery in the study group was 92.00%, which was higher than 60.00% in the control group (P <0.05). The operation time of the study group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group (P <0.05). The satisfaction rate of the study group was 92.00%, which was higher than 52.00% of the control group (P <0.05). Conclusion The clinical effect of reverse island flap of sural nerve nutrient vessel in repairing skin and soft tissue defect of foot and ankle is good, which is beneficial to promote the recovery of flap, and the operation time is short, the intraoperative blood loss is less, the application s afety is high, and the patients are satisfied with the repair eff ect.