Purpose Wounds involving the soft tissues surrounding the Achilles tendon have traditionally been treated by local or distant flaps. This study exams the use of skin grafting as an alternative to flap reconstruction in the salvage of the Achilles tendon in both diabetic and non-diabetic patients. Materials and Methods Forty-five patients with wounds, involving the Achilles tendon, in 49 lower extremities were identified from our limb salvage registry from 1990 - 1999. There were 14 diabetics with 16 wounds and 31 non-diabetics with 33 wounds. The etiology of the wounds included: trauma, infection, vasculitis, pyoderma gangrenosa, ischemia, venous stasis, and cancer. Following debridement wounds were healed by secondary intention (6), skin grafting (24), local flaps (10) or free flaps (8). Results The initial success rate for each procedure was not significantly different: secondary intention 83%, skin graft 83%, local flap 73%, and free flap 83%. There was no significant difference between diabetics and non-diabetics. The overall wound-healing rate was 96% and the average time to heal, (94 +/- 23 days), was not statistically different between therapeutic modalities or between diabetics and non-diabetics. Conclusion Skin grafting is an acceptable alternative form of reconstruction to salvage the Achilles tendon.