There is no gold standard for the treatment of infected bone defects. Reconstruction techniques based on local bone regeneration (non-vascularized bone grafts, distraction osteogenesis) depend on native bone ends for healing. The patients that most benefit from non-vascularized bone autografts are those with small defects with good coverage and infection control. Creeping substitution is a slow, unreliable process, so result predictability is low and regrafting is common. Techniques based on distraction osteogenesis allow almost immediate loading, but they require prolonged external fixation and most patients need secondary procedures. Acute shortening manages simultaneously stability, dead space, and the soft tissues; it is especially suitable for small defects that will not need re-lengthening. Bone transport maintains limb length and is especially useful in cases of deformities or malalignments. Bone flaps replace the defect with healthy bone transplanted from elsewhere in the patient’s body. They have the shortest time to union and lowest complication rate, at the cost of donor-site morbidity and prolonged protected axial load. The patients that benefit from bone flaps the most are those with vascular compromise of the infected site (e.g., previous unsuccessful attempts), a soft tissue defect requiring tissue transfer, an upper limb defect, or a metaphyseal bone defect.