This study retrospectively examined data from 45 patients with diabetic foot ulcers who underwent free gracilis muscle reconstruction from January 1999 to December 2003. Twenty-five patients (55.6%) were men and 20 (44.4%) were women. The mean age was 60.2 years (range, 34-90 years). The mean follow-up was 27 months (range, 6-36 months). The lesions were located on the dorsum of the foot (38.5%), hallux (18.5%), and the fifth toe (12.3%). According to Wagner's classification, 28% of the ulcers were grade 2, 20% were grade 3, and 51.1% were grade 4. Initial management of these patients included control of blood sugar level, proper hydration, administration of antibiotics, treatment of coexisting diseases, and repeated debridements of wounds when necessary. A total of 48 gracilis muscle flaps were harvested for reconstruction. There were 35 (72.9%) patients with complete success when there was complete healing of the flap; 12 patients with partial success when there was some loss of the flap or skin graft, or draining wounds; and 1 patient (2.1%) with failure. There was no infection or hematoma of the flap donor site; only hypertrophic scarring occurred in 3 patients (6.6%). The free gracilis muscle flap is a safe, simple, and effective method for coverage of difficult diabetic foot ulcers. Its use results in good aesthetic and functional outcome and low donor site morbidity.