Composite tissue defects of the midfoot with extensive bone and soft tissue loss represent a unique challenge because they can lead to primary amputation if not reconstructed. One should repair both the bone structure and the soft tissue to obtain satisfactory foot function for basic daily activities. In the present study, we report on a case in which we successfully reconstructed an extensive midfoot defect with iliac bone grafts for metatarsal reconstruction and an anterolateral thigh flap for soft tissue coverage. This technique is a safe, reliable, and functional method, offering single-stage reconstruction compared with other microsurgical techniques used for such defects. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.