Optimum management of open tibial fractures often requires a 'fix and flap' approach with the use of external fixators and muscle or other free flaps. Occasionally, due to the position of the wound and the fracture configuration (e.g. butterfly fragment) the pins or screws have to pass through the flap. Previous methods to overcome this problem have included dividing the flap and then wrapping the flap around the pin; a procedure which may compromise flap vascularity.