Purpose To assess reconstructed lower limb Gustilo and Anderson (G&A) IIIb and IIIc injury outcomes in a major trauma centre. Methodology As our institute has no specific database for these injuries we conducted a retrospective assessment of electronic medical records of all open lower limb injuries from June 2022-2024 identifying G&A IIIb and IIIc injuries. Results We identified 60 IIIb and 7 IIIc injuries (mean age 47, range 14-86). 3 primary amputations for IIIb (5%) and IIIc (43%) resulting in 57 IIIb and 4 IIIc reconstructions. The IIIb cohort had: 40 free and 13 local flaps; IIIc: 3 free and 1 local flap. Soft tissue coverage: 7.54 days (IIIb), 4.5 days (IIIc). Limb salvage rate: IIIb 95% (2 secondary amputations), IIIc 75% (1 secondary amputations). Deep infection/osteomyelitis: 36.8% (IIIb), 50% (IIIc). Length of stay: 28.4 days (IIIb), 79.25 days (IIIc). Number of surgical procedures: 4.3 (IIIb), 11.7 (IIIc). Non-union at 6 months: 8.5% (IIIb), 0% (IIIc). Discussion High-energy open leg fracture injuries are commonly seen in major trauma centres. There is a lack of evidence on long term outcomes to support decision-making on limb salvage over primary amputation. In our study reconstructed despite shorer time to soft tissue coverage, IIIc injuries required longer LOS and ultimately required nearly 3 times more procedures with a high delayed amputation rate of 25% (vs 5% in IIIb injuries). A prospective analysis of IIIb and IIIc outcomes across the state may help guide future practice to optimise patient care and health service resource utilisation.