On the timing of soft-tissue reconstruction for open fractures of the lower leg

The timing of soft-tissue reconstruction for severe open fractures of the l ower leg is considered crucial to the later outcome, and yet pertinent publ ications are few. The purpose of this study was to add some based an eviden ce arguments for the choice of the most adequate timing in the management o f these injuries. Twenty-nine consecutive open fractures of the tibia, incl uding 24 grade 3B and 5 grade 3C fractures, were treated using a protocol o f immediate debridement, early definitive skeletal stabilisation and early soft-tissue reconstruction. Fifteen lower legs were reconstructed after a m ean delay of 4.4 days (range 1-9 days), while 14 lower legs were reconstruc ted immediately, i.e. as an emergency procedure on the day of admission. Bo th groups were comparable for sex, age, type of trauma, associated general injuries, type of fracture, associated arterial lesion, associated tendon r upture, type of soft-tissue reconstruction and duration of followup. All pa tients were reviewed at a mean follow-up of 47 months (range 15-89 months). In the delayed reconstruction group the time to full, unprotected weight-b earing (P = 0.0021), the time to definitive union (P = 0.0049), the number of reoperations (P = 0.0001) and the infection rate (P = 0.0374) were signi ficantly higher. The data suggest that immediate reconstruction is, the gen eral condition of the patient permitting, the timing of choice for soft-tis sue coverage.