The lower extremity can be separated into the upper and lower leg, with the majority of lower extremity reconstruction referring to the distal half of the leg (i.e., knee and below). Bony involvement complicates lower extremity reconstruction and should be approached in a multidisciplinary manner to better coordinate patient orthopedic and reconstructive needs to achieve the best functional outcome for the patient. Although limb salvage is typically the goal, patients should have extensive discussion on the risks of reoperations, risk of osteomyelitis and other related complications, and the potential for these adverse events to affect quality of life. A comprehensive discussion should also include novel amputation techniques as a component of the limb reconstruction algorithm.