The management of lower extremity trauma is multidisciplinary, and the decision of amputation versus salvage may require the involvement of both plastic and orthopedic surgery. If reconstruction is pursued, an orthoplastic approach is critical. It is important to coordinate timely and wide debridement and bony fixation and to reconstruct “like with like” to minimize morbidity and maximize function. Due to improvements in wound care, microsurgery, and surgical technique, more complex wounds are increasingly eligible for salvage and reconstruction. This chapter reviews limb trauma classification, timing of reconstruction, classic reconstructive options, as well as newer concepts in lower extremity reconstruction in the setting of trauma.