A retrospective study was done to ascertain the effectiveness of free-flap tissue transfer in coverage of grade III tibial fractures. Thirteen cases were reviewed from DC General Hospital and Howard University Hospital. The criteria for success were the presence of union, infection, and need for bone grafting. Bone union was achieved in 9 of the 13 patients, 9 patients presented with infection either pre- or postoperatively, and bone grafting was necessary in 6 patients. Three of the patients had flap failure with subsequent replacement and success of two of the flaps. This was a success rate of 75%. Free-flap tissue transfer is an effective approach for the treatment of grade III tibial fractures, particularly when performed in the acute or chronic phase of fracture healing.