Problems in the management of soft tissue injuries in compound fractures are presented. They usually originate from the initial traumatic force, but may be the result of pitfalls of the primary treatment as well. The management of open fractures--as it is performed in this clinic--is presented in detail. After primary stabilization of the fracture attention is directed to the associated soft tissue injuries, which require utmost care in the further course of treatment. Primary wound closure should never be forcefully obtained, since closure under tension will result in severe secondary tissue damage. In our experience temporary open wound treatment and delayed closure is the method of choice in the initial management of open fractures. For temporary cover we successfully use the synthetic skin substitute Epigard. Since we adopted this policy, the rate of infection declined drastically, and anaerobic infections as well as generalized sepsis could be totally avoided.