Lower extremity diabetic wounds have been a challenge to clinical surgeons because of the higher risk of limb ischemia, soft-tissue infection, and soft-tissue loss caused by the pathology of the disease. In the published data, the most commonly used reconstruction techniques include pedicled flaps, microsurgical muscle or musculocutaneous flaps, and microsurgical fasciocutaneous or perforator flaps. However, there is still no consensus about which type of flap should be preferred among various reconstructive options. It is therefore the aim of this study to review current articles describing distal lower extremity flap reconstruction in patients with diabetes to survey reported results from the literature.