Soft tissue coverage was achieved at a median of nine days post-injury utilizing 18 local flaps and 16 free flaps. There was one flap failure in the series due to infection which was successfully replaced. Seventeen of these patients had achieved limb salvage while two had required amputation. Those patients receiving coverage during the acute and subacute time periods had better limb salvage rates and functional results. Soft tissue coverage with local or free tissue transfer is usually effective in the treatment of open tibial fractures and good or acceptable outcomes are often seen.
Early coverage seems to provide the greatest benefit.
Introduction Severe open fractures of the tibia are commonly seen at major trauma centers and are among the most difficult fractures to manage. The special challenges that these injuries present are related to the high energy nature of the injury, the weight-bearing function of the tibia, difficulties with soft tissue coverage and massive wound contamination. Furthermore, due to the poor soft tissue envelope of the tibia and its tenuous blood supply, fracture healing is prolonged even under ideal circumstances. The high energy nature of these injuries often results in extensive soft tissue disruption and bony comminution. Adequate soft tissue coverage is a central element in the management of these patients.