Background: Grade III open fractures of the lower extremity are solemn injuries and not easy to reconstruct and involved free flap implementation which has improved in answering the microsurgery needs. However, little to no studies on the overall performance of clinical outcomes of one flap typology particularly versus local flap. This study aimed to comprehensively evaluate benefits the effectiveness between free flap and local flap in open tibial fractures particularly in Gustilo Anderson III B/C