The use of free flaps in repairing lower extremity defects has enabled reconstructive surgeons to affect a paradigm shift in limb salvage. Complex free flap reconstructions are now routinely being used to preserve limbs that previously would have been amputated. This shift toward limb preservation has prompted surgeons to reevaluate the indications for lower extremity amputation and thus improved patients' quality of life. The timing and management of free flap reconstruction in trauma patients have been refined. In addition, tremendous advances in the multidisciplinary management of bone and soft tissue sarcoma have been made. Neoadjuvant chemotherapy and radiotherapy are now used to reduce tumor size to enable neurovascular-sparing resections that preserve limb function. Although many uncontrollable variables can affect reconstruction outcomes in trauma patients, early intervention with serial debridement, vacuum assisted wound care, and early free-flap coverage can improve limb salvage.