Early versus Late Flap Coverage for Open Tibial Fractures

Abstract

Purpose. To compare early versus late flap coverage for open tibial fractures. Methods. Medical records of 83 men and 6 women (mean age, 38 years) who underwent fixation for open tibial fractures (Gustilo grades IIIB and IIIC) followed by flap coverage within (n=30) or after (n=59) 72 hours were reviewed. All fractures were treated within 24 hours. Outcome measures included bone union, infection, flap failure, the need for secondary procedures to achieve union, and eventual amputation. The early and late flap coverage groups were compared. Results. Early flap coverage was associated with shorter length of hospitalisation (31.4 vs. 55.8 days, p<0.01), lower deep infection rates (23% vs. 54%, p<0.01), and smaller number of surgical procedures (6.4 vs. 9.2, p=0.01). The 2 groups did not differ significantly in terms of the time to bone union, flap failure, amputation, and the need of secondary procedures to facilitate bone union. Conclusion. In severe open tibial fractures, early soft-tissue coverage (within 72 hours) was associated with more favourable outcomes in terms of length of hospitalisation and infection.