The adequate and early replacement of soft tissue in the lower leg is equivalent to the management of bone and prevention of osteomyelitis. The acute or delayed primary management of soft tissue loss with early flap coverage prevents infections. In the treatment of osteomyelitis, flap coverage provides the necessary blood supply for healing. In the first stage we remove bone until bleeding indicates viable tissue, gentamycin-PMMA-chains are introduced before flap coverage. In the second stage, if necessary, we substitute the gentamycin-PMMA-chains with bone graft.