Introduction: The surgical bone-covering technique is used to cover and protect exposed bone in cases of open fractures. The objective of this research was to explore the therapeutic dimensions and the evolution of surgical bone-covering procedures for open leg fractures in adults in Bamako. Methodology: A retrospective study, conducted from January 2023 to December 2025 in the Department of Orthopedic and Trauma Surgery at the Gabriel Touré University Hospital (Mali), examined 20 cases of tissue loss in the leg, with a follow-up period of at least 10 months. Results: We recorded 20 patients with open fractures of the leg, with a sex ratio of 9. The mean duration of hospitalization was 17.6 days (range: 7–33 days). The mean time to soft-tissue coverage was 18.43 days (range: 0–36 days). The mean size of the skin defect following debridement was 12.5 centimeters. Outcomes were favorable in 18 cases (90%), resulting in skin healing. Bone consolidation was achieved in 17 cases (85%). Complications consisted primarily of flap necrosis, which occurred in 3 cases (15%). Conclusion: Surgical bone coverage is an important step in the treatment of open leg fractures, with encouraging results in our series.