Abstract Background:  External fixation (EF) remains to be the golden standard for Gustilo type IIIB fractures, which has low risk of infections. Intramedullary nailing has already been reported to be effective in certain cases. We document a report of a more progressive approach in 5 consecutive cases successfully managed with the free flap-over-plate technique.Methods: From Jan, 2010 to Dec, 2012, five patients of  Gustilo type IIIB fractures were treated at our center using  free flaps transfer over the plate and exposed bone.Results: All the flaps healed uneventfully. The bone union time ranged from 17 months to 34 months. Two patients had chronic infection under the flap. It was healed spontaneously under daily wound care.Conclusions : An exposed type IIIB fracture  can be treated successfully with direct free flap coverage and plate fixation until fracture union occurs. A wound with dry and fresh granulation is the key for the success of this treatment protocol.