For the patient facing a major lower extremity amputation, the surgeon's goal should be to salvage a residual limb with the maximum amount of function. This requires coordinating length with the available prosthetics and tenodesing muscle to optimize joint motion and maintain muscle tone. This article explains a systematic approach to major lower extremity amputation. We believe outcomes can be improved through careful preoperative evaluation and optimization of biomechanics, blood flow, and infection. Thoughtful planning and the creative use of remaining viable tissue can give most amputees a highly functional lower extremity.