Long-term results on the use of structural allografts (> or = 10 cm) to reconstruct large skeletal defects sustained during high-energy, open lower extremity fractures have not been reported. Eight patients are retrospectively reviewed at postallograft time periods ranging from 18 to 93 months. Two patients required reoperation for noninfectious causes, and each healed uneventfully. Four individuals developed infectious complications, but only one required complete allograft removal (amputation). The others remain infection free at follow-up. Using any of three different rating systems, excellent functional outcome results from this method of reconstruction in an otherwise exceptionally challenging extremity for limb salvage.