Background: In a Guatemalan public hospital, 3710 fractures were diagnosed in 2016, of which 723 corresponded to the tibia. Of these tibial fractures, approximately 15% were exposed. Skin coverage in exposed fractures has always been a challenge for the attending physician. In the case of the lower limb, there is the option of making a sural flap. Objectives: To determine the effectiveness of the sural flaps when utilizing this technique as a treatment for exposed fractures in the lower limb in adult patients. Methods: A prospective observational descriptive study, the evaluated patients and patient files as primary and secondary sources, respectively, and control with observational variables. The sample consisted of 24 patients who got 3 follow-up appointments at 5 days, 2 weeks, and a year. Results: The results manifested effectiveness of 95.8%. The area most affected was the lateral malleolus. Additionally, comorbidities, schooling, and gender showed no influence on the effectiveness of the flap. Conclusion: The effectiveness of the sural flap technique in exposed fractures was 95.8%. Recommendations: Physicians ought to consider using the sural flap as the treatment of choice for skin coverage defects localized in the distal and middle third regardless of the leg and cause of the defect.