Chronic lower extremity (LE) wounds represent a growing source of morbidity, limb loss, and health care expenditure, driven by rising rates of diabetes, vascular disease, and advanced age. Effective management requires a comprehensive understanding of underlying wound pathophysiology, etiology, and patient risk factors. This article reviews the assessment and multidisciplinary management of chronic LE wounds, emphasizing infection control, vascular optimization, and biomechanical correction. Institutional outcomes using a coordinated “vasculoplastic” approach demonstrate that complex limb salvage for chronic LE wounds with free tissue transfer can achieve high flap success, durable wound healing, and meaningful functional recovery in high-risk patients.