Locoregional flaps play an important role in soft tissue reconstruction of the lower extremity and should be considered as an effective option in both function and resurfacing. Reconstruction of the lower extremity requires recognition of not only the functional and textural demands of the recipient but also the anatomic and morphologic characteristics of the donor tissues. Selecting the correct flap and navigating the postoperative recovery to arrive at functional restoration remain a significant challenge. Tissue composition of the flaps used in these reconstructions, their indications, and their advantages or disadvantages constitute a very large spectrum. If the indications for each flap are understood and the vascular pedicle of each is carefully preserved, these flaps can be used to provide relatively simple and reliable coverage of selected medium to large-sized soft tissue defects of the lower extremities. This chapter summarizes muscle and adipofascial flap options that can be widely and easily applied in the light of our current knowledge and experience for the reconstruction of medium to large-sized defects of the thigh, knee, and leg.