Lower extremity reconstruction has evolved from a focus on limb salvage to prioritizing functional restoration. This shift has been driven by advances in microsurgery, fixation techniques, imaging, and the integration of orthopedic and plastic surgery expertise through the orthoplastic approach. This collaborative model emphasizes simultaneous bone stabilization and soft tissue reconstruction, recognizing their interdependence in healing. Evidence shows reduced infection rates, faster definitive treatment, and improved functional outcomes with orthoplastic care. Modern strategies favor the “reconstructive elevator” concept, enabling tailored, often single-stage, solutions using perforator-based and microsurgical flaps to address complex bone and soft tissue defects effectively.