A 73-year-old man sustained a severe injury to his lower leg, causing a distaltibial bone defect and extensive soft tissue damage. The patient underwent acute conventional debridement and external fixation leaving a 7 cm bone lesion in the tibia and a soft tissue defect in the leg. The contralateral fibula was used to provide bridging vascularized intramedullary fixation and its skin paddle was used to cover the soft tissue defect. This case demonstrates that a free vascularized fibular osteoseptocutaneous flap can be used for simultaneous intramedullary fixation and soft tissue coverage.