Locoregional flaps play an important role in soft tissue reconstruction of the lower extremity and should be considered an effective option in soft tissue reconstruction. The medial hemisoleus muscle flap and the distally based sural artery flap can be elevated because of unique vascular anatomy and more advanced surgical techniques in flap dissection. Each flap can replace free tissue transfer as the first choice for soft tissue reconstruction of a less extensive wound in the distal third of the leg. Patient selection and detailed knowledge of the flap and its advanced technique for flap dissection are keys to success.