Tissue defects of the heel region are a challenging problem. Various reconstructive techniques were performed in 44 patients with 59 defects around the heel region, who were treated between 1994 and 1999 following a traffic accident in 27%, a burn injury in 25%, and other traumatic causes in 48%. Free flap coverage was performed in 20 defects (36%), local flaps were used in 15 patients (27%) and autologous skin transplantation in 21 patients (36%). The overall complication rate was 18% with the highest rate after local flap procedures. A therapeutic strategy was developed, which is based mostly on the localization and extension of the defect area.