Although segmental bone loss together with a soft-tissue defect after debridement of a chronic osteomyelitic lesion of the tibia represents a challenging problem for the reconstructive surgeon, bone management has not usually been carried out at the time of soft-tissue coverage. In a one-stage procedure, we treated a patient who had suffered from chronic osteomyelitis of the tibia for 12 years, using a pedicled vascularised double-barrel fibular flap together with a pedicled medial gastrocnemius muscle flap, immediately after radical debridement of the osteomyelitic lesion. Bony union was obtained at 4 months. Full unprotected weight-bearing for normal walking was achieved 10 months after fibular transfer. Follow-up at 2 years showed no recurrence of the osteomyelitis. (C) 2002 The British Association of Plastic Surgeons.