A prerequisite for successful treatment of severe trauma to an extremity is radical débridement of the bone and soft tissue destroyed by the trauma. The inevitable bone and soft tissue injuries that ensue have to be accepted so as not to endanger the infection-free healing process. For subsequent reconstruction of the defects, particularly the well-established autologous methods are available. Soft tissue reconstruction is combined with local or free flaps in a one-stage procedure to rebuild the bone defect by fibular transfer, staged reconstruction with autologous cancellous bone, or segment transfer according to Ilisarov. The duration of the entire treatment process is often quite long and can be considerably shortened by modification of the bone reconstruction (conditioning the defect before autologous bone graft, nail support of the distraction procedure).