Devastating limb injury is often the result of high-energy trauma and is characterized by destructive injury to soft tissues, bones, nerves, and vasculature [1]. Reconstruction is a particularly difficult challenge for even experienced surgeons. Anatomical limitations are most apparent in lower extremity injuries involving the distal third where there is little to no soft tissue coverage beyond the skin and subcutaneous layers. These defects often require free tissue transfer. Wound etiology—whether trauma, vascular, or oncologic—has further impact on the arterial inflow and/or venous outflow, making patient selection and optimization paramount for successful salvage.