The outcome of microsurgical reconstruction of septic nonunion of the tibia was described. The series consisted of 15 patients, with Cierny Stage IVA or IVB septic nonunion of the tibia, who were treated in the microsurgical practice of a major tertiary care hospital. Patients with a documented end point of either union or amputation were eligible for inclusion. Patients were treated with wound excision followed by soft tissue and skeletal reconstruction. The outcome measures of interest included clinical measures (time to union or amputation, surgical complications, wound status) and health related quality of life measures (Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, and patient satisfaction questionnaires). The average followup time was 3 years. There was 1 microvascular complication and no failures. Two of 15 patients (both Cierny IVB) required amputation after reconstruction. The time to union after bone grafting was an average of 6.5 months in May et al Type III legs (n = 12), 3 months in May et al Type IV legs (n = 1), and 16 months in May et al Type V legs (n = 2). Nine patients completed the questionnaires; Short Form-36 scores were below normative values for the same age group. Scores on the activity limitation component of the Western Ontario and McMaster Universities Osteoarthritis Index seem to be comparable with those of individual's scores after total knee replacement surgery. Despite relatively low scores on the questionnaires, most patients were either very or completely satisfied with the outcome of surgery. Patients often reported that satisfaction was related to preservation of the limb.