Successful salvage of Gustilo IIIB tibial fractures with microvascular transplantation has been documented in the young. Similar results from the application of these techniques to the elderly has not been demonstrated. An 8-year review located 12 patients 60 years or older who underwent soft tissue reconstruction of IIIB tibial fractures with microvascular transplants. Ten patients were available for long-term follow-up (average 43 months). To date, 80% remain ambulating with no secondary amputations or late infections reported.