This study is a retrospective review of all reverse flow fasciocutaneous flaps for reconstruction of lower extremity trauma performed at a single institution between 1990 and 2005. Various parameters of the injury, type of reconstruction, and outcomes were evaluated. Approximately one hundred patients underwent lower extremity reconstruction with reverse flow fasciocutaneous flaps including the sural flap and other flaps based on perforators from the peroneal and posterior tibial arteries. The data base included extremity injury severity score, bone/soft tissue defect, procedure(s), use of prior delay, time to wound closure and bony union, and finally, ambulatory outcomes. Prior delay is a crucial factor in success in the application of reverse flow fasciocutaneous flaps in lower extremity trauma. Reverse flow flaps should be the primary option for closure of lower extremity complex wounds.