Background: To establish, from the health system perspective, the cost-utility relationship of limb reconstruction compared with primary amputation for patients older than 32 years with grade IIIB and IIIC severe lower limb trauma in Colombia, S.A. Methods: A Markov model was built including different short-term and long-term states that represent the main events that a patient could experience after a lower limb amputation or a reconstruction. A 42-year time horizon was considered for the base case. Transition probabilities were obtained from a systematic review of the clinical literature. The health outcome selected was the quality-adjusted life years. Costs were determined by expert consensus using the standard case methodology, and valuation of resources was conducted with national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. Results: In the base case, the reconstruction of the limb compared with primary amputation was a dominant strategy; that is, reconstruction provides more quality-adjusted life years at a lower cost. This result changed only when the time horizon was less than 6 years or when the probability of a secondary amputation was >65%. Conclusions: Limb reconstruction is a dominant strategy compared with primary amputation, which is a conclusion that holds in most scenarios this study examined. Therefore, it should be considered in patients who, according to the clinical criteria and the severity and characteristics of their trauma, can benefit from this technique. Level of Evidence: Economic Level II. See Instructions for Authors for a complete description of levels of evidence.