SummaryWe present a technique in which soft tissue defects are covered by free flaps at the time of frame application. This technique allows treatment of segmental bone defects, nonunions, malunions, and osteomyelitis with traditional Ilizarov and modern soft tissue coverage principles. Patients undergo fewer operative procedures for treatment of wounds and have shorter hospitalizations, and the flap coverage places no limitations on distraction or translation of the fracture fragments.