Lower limb tendon injuries are devastating for the patient’s stability, movement, and overall quality of life. The Achilles tendon is considered the most commonly injured tendon, and as such has received the most attention in published literature. Tendon injuries are often coupled with overlying soft-tissue defects, either as a result of the causative insult or as a complication of the primary management approach that has led to tissue debridement and further increase in defect size. Complex tendocutaneous defects present a significant surgical challenge. Simultaneous tendon and soft-tissue reconstructions with microsurgical composite free flaps have shown promise, employing a single donor-site flap to repair the soft-tissue layer and an adjoining tissue extension for neotendon reconstruction. This chapter will summarize these issues and present a case where an anterolateral thigh flap with vascularized tensor fasciae latae was used for an Achilles tendon reconstruction.