A wide variety of soft tissue wounds occur in tandem with bony traumatic extremity injuries. The most widely researched are those that occur in the setting of open fractures, and consensus on this topic has evolved in recent years. Many studies have scrutinized both timing of debridement and staging of soft tissue coverage, concluding that optimal windows indeed exist. Further research has focused on antibiotic drug-delivery devices and negative pressure wound therapy (NPWT) as useful adjuncts, both for defects or dead space that coincide with open fractures and those present in isolation. Their specific indications (and contraindications) must be understood to ensure clinically appropriate application, as not all circumstances are suitable for these treatment pathways. Internal degloving injuries represent another unique entity whose management must be targeted based on injury characteristics. Consideration always should be given to alternative treatment options when surgery is either inappropriate or avoidable.