Soft tissue reconstruction of the lower extremity presents unique challenges due to functional, structural, and esthetic demands. Locoregional flaps remain a valuable option for limb salvage, particularly in patients unsuitable for free tissue transfer or in centers without microsurgical capabilities. Advances in imaging and perforator flap planning have improved success rates and broadened indications for locoregional flaps. These flaps offer reliable outcomes comparable to free flaps, with potential benefits in operative time, hospital stay, and cost. Patient-reported outcomes and new assessment tools are increasingly informing flap selection and surgical planning for optimal functional recovery.