Management of severe open fractures and non-viable injuries of the tibia remain both difficult and controversial. The orthopedist must carefully assess the injured limb in order to determine whether it should be salvaged or amputated. The difficult operative procedure requires thorough knowledge of microsurgical techniques necessary to repair vascular and neural injury. Over a 10 year period, 13 patients with non-viable, open fractures of the tibia underwent limb salvaging attempts using identical treatment protocol. 5 of the 13 limbs were salvaged, while 8 limbs were later amputated, because of either failure of revascularization or severe infection. 2 patients died; one with good circulation in the limb because of a massive pulmonary embolism 5 days postoperatively and the other because of severe septicemia 13 days postoperatively.