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Extensive compound fractures of the distal lower extremity may result in chronic infection of the deep tissues and bone if primary healing does not occur. Treatment may require several operations and prolonged hospitalization. In an attempt to improve the management of such problems, 18 patients who had chronic bone-exposure wounds and four patients who had extensive compound fracture wounds of the distal lower extremity were treated with radical debridement, intravenous antibiotics, and microvascular transfer of vascularized tissues for immediate wound closure. All wounds healed, and there was no evidence of recurrent infection during a mean follow-up period of 19.3 months in the patients with chronic wounds and 16.3 months in those with acute wounds. In selected patients this free-tissue-transfer method of wound closure appears to have considerable advantages over conventional methods of management.

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