Open fractures complicated by infection, or those requiring extensive soft-tissue procedures, are disabling problems for patients and result in significant costs for the health care system. As an adjuvant to current protocols involving open fractures, antibiotic bead pouches (ABPs) provide high concentrations of local antibiotics and can help reduce infection rates. Vacuum-assisted closure (VAC) has been shown to decrease the need for, and enhance the success of, free-flap coverage for traumatic wounds that are significant enough to preclude primary closure, delayed primary closure, or healing by secondary intention. These 2 modalities may help decrease the complications and costs involved in the management of severe open fractures. In this article, we review the theory, technique, and efficacy of ABPs and VAC in the management of severe open fractures.