Demographic changes of the industrialised modern society can be recognised throughout every medical specialisation. In the past plastic surgery had a main focus in the reconstruction of posttraumatic disorders but nowadays the typical disorders of the elderly and "civilization diseases" became a major part of reconstructive surgery. In this context the preservation of the lower extremity is a major concern of the plastic surgeon. Especially in patients with diabetes and its typical peripheral atherosclerosis we have to treat peripheral ulcers in an interdisciplinary setting including diabetologist, vascular and plastic surgeon to preserve the endangered extremity.