This chapter discusses soft tissue coverage for lower extremity. Infection and nonunion are the two major problems of open fractures with soft tissue loss. Both these complications can be reduced by timely and proper management of associated soft tissue loss. The use of different metallic implants or explants has probably had little effect on the incidence of infection or nonunion following open fracture, these outcome criteria depending mainly on the nature of the injury and quality of the treatment of the soft tissue injury associated with the fracture. Established principles of management of soft tissue loss in open fracture are detailed in this chapter. Wound cultures are useful to isolate organisms and for finding the antibiotic sensitivity in the presence of clinical infection. The adequacy of debridement determines the rate of wound infection, bone union and the ultimate success of reconstruction.