Objective To describe the method and the clinical effect of the transplantation of cutaneous iliac flap and external fixation for the repair of the defect of tibia and soft tissue of the leg. Methods Between May 1998 and May 2001, 22 tibial fractures associated with bone and soft tissue defects of the leg were treated with Bastiani external fixation device and transplantation of the groin osteocutaneous flap with the deep circumflex iliac vessels. There were 15 males and 7 females with the the age ranged from 16 to 58 years and an average of 37 years. The follow-up period ranged from 5 to 36 months, with an average of 25. 5 months. Results All the osteocutaneous flaps survived completely after operation; the defects were repaired at one setting; the external fixation apparatuses were steady and the fracture healed smoothly. The bone graft healed with the host bone in three to six months. The recovery of function of the limb were satisfactory. There were no major complicaton in this series. Conclusion The groin osteocutaneous flap with the deep circumflex iliac vessels can be used to repair the bone and soft tissue defects in the tibia at one setting. The external fixation device provides a convenient condition for bone graft and prevents the stress protection effect.