The development of microsurgery and the expansion of plastic surgery techniques have led to a significant increase of surgical options for the salvage of the lower extremity. The traditional methods still have a role, but many authors have demonstrated a superiority of free and sophisticated regional flaps. This article gives an overview of treatment algorithms and surgical options. A therapeutic goal for the surgeon is to select the appropriate procedure with respect to the patient's medical condition and rehabilitation potential, the defect, and the surgeon's technical skills to achieve durable, permanent, pain-free, and functionally and aesthetically satisfying defect coverage.