The assessment and management of lower limb trauma have evolved greatly in the modern age and its development can be attributed to necessity on the battlefield.Amputation indications were first described in the 16th Century by Ambroise Pare who reported its need in complex traumas such as compound fractures and extensive soft tissue injuries. Despite the introduction of soft tissue debridement, amputations rather than limb salvage were still widely practised. The American Civil War witnessed the greatest number of limbs lost in an American conflict and was reflected in the improved amputation mortality rate of 40% when compared to previous military experiences. Aseptic techniques and anaesthesia heralded a sea-change in the management of lower limb trauma. During the Franco-Prussian War, aseptic surgical techniques adopted by German military doctors led to a reduced risk of mortality and morbidity. The development of anaesthesia also resulted in surgeries which were safer and more successful. By World War One, these advances led to changing indications for amputation, and it was recommended for either irreparable vascular injury, two compound fractures of the same bone or sepsis. By 1958, the Emergency War Surgery-NATO Handbook heralded limb amputation as a ‘surgical defeat’ and limb salvage deemed possible even in the setting of shock and sepsis with the advent of vascular reconstruction, antibiotics and blood products. The progress in lower limb traumatic management can be directly attributable to the experiences and necessity of war-time injuries and their contribution has formed the foundation of modern lower limb trauma management.