Pediatric lower extremity reconstruction, especially following trauma or oncologic resection, presents unique challenges requiring a multidisciplinary approach. Management emphasizes early, thorough debridement, appropriate fixation—often with flexible intramedullary nails—and timely, well-vascularized soft tissue coverage. Nerve injuries are addressed with autografts or allografts, with children demonstrating better regenerative capacity than adults. Postoperative protocols focus on immobilization, pain management, psychosocial support, and structured rehabilitation, with family involvement crucial for adherence. Microsurgeons are essential for complex reconstructions and addressing complications like critical limb ischemia. The field continues to evolve, prioritizing functional limb salvage and long-term quality of life for pediatric patients.