Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners. This decision is largely dependent on the patient’s premorbid health and function, functional goals and preferences, and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing. When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise, the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.

Aim: Mass casualty incidents (MCIs) are a devastating source of morbidity and mortality, testing the infrastructure of acute care management and challenging the ability to reconstruct limbs. Herein, we look to further a discussion on upper and lower limb reconstruction following MCIs.

Methods: Review of the literature, including our institute’s experience with the 2013 Boston Marathon Bombings, the 2015-2016 Terror Attacks in Ankara, and the 2010 earthquake in Haiti, pertaining to extremity reconstruction following MCIs.

Results: The three aforementioned case profiles highlight extremity wounds associated with MCIs and the subsequent reconstructive role of plastic surgeons. Surgical intervention or temporization of extremity wounds is a critical responsibility of plastic surgeons in this setting. Limb salvage is possible and often the preferred option following disasters.

Conclusion: Intentional or naturally occurring MCIs are a grim reality. Successful response to these events requires prompt mobilization of emergency medical staff and hospital activation. Plastic surgeons play a paramount role in multidisciplinary management of trauma with a particularly important involvement in limb reconstruction.