58 patients following Gustilo IIIB open tibial fractures, treated by serial debridements, osteosynthesis and microvascular free tissue transfer were investigated after an average of 6 years. Assessment of life satisfaction was done by means of a proven valid and reliable test instrument (FLZ-"Fragen zur Lebenszufriedenheit"). Further specific questions on treatment satisfaction, aesthetic result, occupation and income were added to this questionnaire. Significant discrepancies of the items recreational activities, income, occupation and partnership, productivity, mobility and pain were evaluated in comparison to available data of healthy west german population. The calculated global index of life satisfaction and health differed significantly from the established index of west german population. Although specific aspects like aesthetic result, donor site morbidity, pain and even function were critically judged, 91% of the patients were satisfied with the long term result of the treatment. None of the patients thought that an initial amputation probably might have been a better solution. The postrehabilitation employment rate was 64%. Limb salvage of Gustilo IIIB fractures by means of a multidisciplinary treatment protocol is able to afford useful and satisfying long time results. However, an impairment of quality of life, at least in specific items has to be considered.