The management of posterior heel defects whether the result of trauma or post-operative that result in a loss of the Achilles tendon and overlying skin is complex and challenging. Various techniques have been employed to reconstruct these compound defects often comprising of a free tissue transfer combined with a fascial tendon reconstruction. We present a single-stage method of Achilles tendon reconstruction based upon a local vascularised tendon graft combined with a free antero-lateral thigh flap transfer and a review of the current literature.