Soft tissue defects of the extremities are infrequent within the spectrum of general surgery and are predominantly found with perfusion disorders of macro- and microcirculation in the lower extremities. In the upper extremity, they are more frequently seen after i.v. cytostatic drug administration and tumor resections. This article describes the most frequent causes of complex defects of the extremities. Common flaps for the reconstruction of these defects and the pathway to decision making are elucidated.