Optimal decision making in reconstruction of soft tissues after massive orthopedic trauma is mission-critical to a favorable outcome. In the broadest definition this reconstruction does not just mean a large soft-tissue placed on the bony injury—but rather that the injured patient regains as full a functional recovery, is not narcotic or antibiotic dependent (as many patients with recurring osteomyelitis, plate infection are) and has as little of a disfigurement of the donor and recipient sites as possible. Many argue this is a tall order—and perhaps so. But given where we are in 2012, with advances in all trauma-related fields including imaging, injury scoring, orthopedic reconstruction, it is not too much to expect that plastic and reconstructive methods too run with the winners. An optimal result depends heavily on the following key reconstructive elements described below. (1) timing of reconstruction, (2) choice of soft tissue, (3) anticipated functional outcomes, (4) composite orthoplastic team. Critics may argue that this approach is oversimplified. But on further and more thorough examination it becomes amply clear that these 4 factors play a sentinel role: Here, we describe these aspects in detail.