“Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation

•Primary free anterolateral thigh flap with the Masquelet technique is effective for reconstruction of Gustilo grade IIIB/C open fractures.•It is safe to switch from external to internal tibial fixation within 7 days while covering the wound with a flap during the initial operation•We describe the treatment of 15 patients with Gustilo grade IIIB/C open fractures using the combined approach.•Three-stages are proposed: 1) prompt debridement, 2) repair and internal fixation in <7 days, 3) autogenic cancellous bone graft of the defect..