Objective To introduce the clinical experience of localdistally based turnover adipofascial flap for small to medium size wound of the extremities. Methods From 1994 to 2003, 33 cases of distally based longitudinal neuro-veno-adipofascial turnover adipofascial flap (axial perforator pattern in26, random pattern in 7) were transferred in the forearm (19) and lower leg (14).These flaps were all raised in the forearm or lower leg as local flaps. The length (pedicle plus flap) was 9 to 18 cm and the width was 3 to 4 cm, with L/W ratio of 3 to 5∶1. After transferring by 180° turnover, a splitthickness skin graft was used tocover the fascia surface. Results All the 33 flaps survived. The donor sites were closed directly, and the recipient sites were covered with full-or splitthickness skin grafts. Both donor and recipient sites healed primarily. Conclusion Turnover adipofascial flap is a simple and reliable method for small to medium size wound of the extremities.