Microsurgical free tissue transfer may be the only reconstructive option for lower extremity limb salvage. However, the functional and aesthetic results following free tissue transfer after initial salvage may be suboptimal, thus requiring secondary surgeries to facilitate definitive wound healing and/or refinement. A multi-institutional retrospective cohort study was performed including patients who underwent lower extremity free tissue transfer from January 2002 to December 2020. Our primary outcome variable was the presence of secondary surgery after free tissue transfer for lower extremity reconstruction. Independent variables (wound etiology, flap, donor type, recipient, co-morbidities, etc.) were collected. Secondary surgery was categorized as (1) procedures for definitive wound closure and (2) refinement procedures. Multivariable logistic regression was performed to determine which variables were independently associated with the outcome. Four-hundred-and-twenty free tissue transfers for lower extremity reconstruction were identified. Secondary surgery was performed in over half (57%) of the patients. Presence of diabetes (OR: 2.0, p: 0.01, 95% CI: 1.2-3.5) and use of a latissimus dorsi donor (OR: 2.4, p: 0.037, 95% CI: 1.1-5.4) were predictors of wound closure procedures. Fasciocutaneous (OR 3.6, p: <0.001, 95% CI 1.8-7.2) and myocutaneous (OR: 3.0, p=0.005, 95% CI 1.5-9.9) flaps were predictors of refinement procedures when compared to muscle-only flaps with skin grafts. The majority of lower extremity free tissue reconstructions required secondary procedures to provide definitive wound closure and/or refinement. Overall, this study provides predictors of secondary surgery that will help formulate patients' expectations of lower extremity limb salvage.