Lower extremity soft tissue sarcomas (STS), comprising over 50% of all soft tissue sarcomas, necessitate diverse reconstruction after tumor resection. Simultaneous reconstruction is favored after resection with clear margins, while delayed reconstruction is indicated for unclear margins, wound dehiscence, and insufficient soft tissue coverage. The reconstruction approach depends on defect size, location, expected functional loss, involved structures, and the presence of radiotherapy. Thigh reconstruction often involves primary closure, skin grafts, or local flaps, with free tissue transfer for more complex cases. Lower leg reconstruction varies by region, utilizing local flaps, perforator-based flaps, or microvascular free tissue transfer. Foot and ankle STS, historically treated with amputation, now lean toward limb salvage due to advancements in microsurgery and oncological treatment. Overall, a multidisciplinary approach, including plastic surgeons, is crucial for optimizing functional and aesthetic outcomes in lower extremity reconstruction.