Hardware extrusion can occur at the donor site and manifest either in the short­or long-term setting. Because of the nature of the procedure (i.e., ap elevation of the overlying native soft tissues with underlying bone harvest), the plate can be quite vulnerable to exposure despite attempts to cover it with underlying local mus­cle prior to donor site skin grafting. If sufcient adjacent muscle tissue is not ade­quate for durable hardware coverage, consideration should be placed on performing a local fasciocutaneous advancement ap in an effort to ensure viable hardware coverage with additional soft tissue security to prevent the possibility of hardware exposure. However, despite best efforts, tissue may break down, leading to hard­ware exposure. Unlike tendon exposure, if hardware becomes exposed, biological acellular matrices are not viable treatment options, as direct placement over the exposed hardware will not facilitate matrix incorporation. Acellular matrices require vascularized wound beds and will not “take” over exposed metal implants. Therefore, the provision of vascularized tissue coverage is required. The level to which the hardware is exposed, as well as the available surrounding soft tissue, will direct the plan of care for coverage. For small- to medium-sized wounds, there are a variety of fasciocutaneous local skin ap options available for wound reconstruction. However, if local soft tissue is not available or inadequate, a two-stage groin ap can be per­formed based on the supercial circumex iliac arterial system. In the rst stage, the ap is elevated and inset over the exposed hardware defect; the second stage requires division of the ap and closure of both donor and recipient sites, generally 2–3weeks later. Alternatively, if all local or pedicle options are exhausted or unavailable, a second free ap can be considered for coverage of the exposed hardware.