<p>Open fractures of the lower extremity remain challenging to manage even in the most experienced surgical teams. These injuries when they present with bone loss pose even greater challenges with often unpredictable outcomes. Whilst traditionally, bone transport has been used as the surgical technique to treat open long bone injuries with bone loss, recently the Masquelet technique has gained great popularity amongst surgeons to manage these injuries. Understanding better the role of the induced membrane, its molecular signature (possessing angiogenic, osteogenic and inductive properties) and the capabilities that exist to improve the biological potency of the graft materials implanted, as well as appreciating the contribution of several tips and tricks that have been developed (membrane preservation and graft optimisation), good results can be expected. Additionally, it appears that from the health economic perspective, the technique is associated with less costs compared to bone transport. Herein the Masquelet technique is described for the management of open fractures of the lower extremity presenting with bone loss providing useful tips on how complications can be reduced whilst improving clinical outcomes.</p>