Background: Combined trauma of the lower third legofGustilo grade (GIII) B-C open tibia shaft fractures have a wide spectrum of injury to the bone and soft tissues. Objective: To evaluate the outcome of using Ilizarov external fixator and cross leg flap in patients with combined traumatic (GIII) B-C open lower thirrf tibial  fractures. Patients  and methods:  This prospective study was conducted between 2008 and 2012 on 9 male patients of age between 18 to 42 years {average 37years). 4 patients were of Gustilo type !JIB with extensive periosteal stripping and 5patients of Gustilo type IIIC. 2patients were acute trauma (6-12) hours and 6 presented late  (2-5months after injury).  Exposure of bone and/or hardware was the mcyor problem in these patients. Nerve injury was negative in all patients. A protocol  for sequential staged reconstruction and preoperative planning was arranged by the orthopedic and plastic surgeon in all cases. We used random pattern  fasciocutaneous cross leg flap as soft tissue cover along with modified 3/8 Ilzarov frame (modified by orthopedic author) for tibial fracture with or without bone defect. Total treatment time till removal offixate  ranged from 5 to 11 months. Follow up was at least 3 years after Ilizarov fixator removal. Results:  Most  flaps survived, two  had marginal necrosis and  one  superficial epidermal necrosis. No complications  were related to the donor  site, flap, or by immobilization.  Each patient resumed essentially normal gait and activity without stiffness ofjoints related to the flap or Ilizarov fixator. Complete failure occurred in one patient due to persistent severe infection and single vessel limb and underwent amputation. Conclusion: This study showed how the cross leg fasciocutaneous  flap can be easily raised through an Ilizarov ring and can be transposed anteriorly  to cover soft tissue defects in the lower thirrf of the leg without losing the stability of the construct