Armed conflicts produce complex and severe injuries, the majority of which are found in the extremities. Today’s advancements in reconstructive surgery allow for many of these injuries to be treated other than by amputation. Challenges of limb reconstruction in war settings are nonetheless numerous and include extensive tissue damage, contamination, and logistical delays in care. The present chapter attempts to delineate the most common microsurgical techniques used in conflict settings for management of lower extremity injury.