SummaryDebridement of necrotic bone is critical to unite tibial fractures. Free flap reconstruction is done using half pin frames followed by delayed Ilizarov reconstruction after flap maturation. Antibiotic beads are used to resuscitate the wound. Antibiotic spacers are used to maintain a soft tissue tunnel for reconstruction. Bone loss can be reconstructed by acute shortening, lengthening, intercalary transport, or a combination of these techniques.