Introduction Treatment of patients with open fractures of long bones with soft tissue defects remains one of the most difficult tasks of current traumatology. Material and methods We repor a clinical case of the treatment of a patient with an extensive purulent wound, a defect in the tibia, chronic damage to the anterior neurovascular bundle, tendons and muscles of the anterior and lateral groups of the lower leg, post-traumatic severe lymphedema of the right foot. The complex of the treatment

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... rocess included debride-ment of the wound, orthoplastic surgery using Ilizarov transosseous osteosynthesis and elements of plastic surgery. The defect of the right tibia was managed using a non-free vascularized peroneal compound flap from the opposite tibia. Results The treatment of this patient resulted in the arrest of osteomyelitis, a significant reduction in foot lymphedema, restoration of weight-bearing and functional capacity of the right lower limb. This was achieved by replacing a significant defect in the tibia and soft tissues under conditions of long-term wound and scar processes and compromised main blood flow in the affected lower leg. Discussion The main operations for management of complex defects in the tissues of the lower leg are demonstrated. Among them, the main ones are transosseous osteosynthesis according to Ilizarov and microsurgical replacement with a vascularized complex of tissues.