Introduction: Secondary complex microsurgical reconstructions after amputation and severe trauma injuries are often necessary to optimize functional outcomes. Methods and Patients: We reviewed eight patients who underwent extensive reconstruction after severe trauma. The details of secondary procedures are further described in the article. A literature search was performed using the National Center for Biotechnology Information (NCBI) database for studies evaluating secondary procedures after complex reconstructions. Discussion: To date, the order and the need for performing secondary procedures have yet to be fully defined. The tissues encountered include skin, soft tissue, bone, nerve, joint, and tendon. Conclusions: We described the use of a decision-theoretic approach to the secondary reconstruction. Treatment of a complex trauma should be measured by functional outcome.