A turning point in the surgical history of the open tibial fractures: osteosynthesis associated with immediate cover in the most serious injuries of the soft tissues

A brief history of the treatment of open leg fractures (OLF) points out the problems posed by the present therapy with regard to the soft tissues in t he most serious cases (type III from cauchoix, Duparc, type III A and B fro m Gustilo). Which strategy should be foremost, knowing that the debridement , stabilization and cover are the three essential procedures? Rigourous deb ridement certainly carries unanimous approval but some are opposed to this procedure during the first few days Also widely recognized is the beneficia l aspect of early cover when regarding aseptic evolution, consolidation, lo w rate of complications, rehabilitation and the patient's helplessness. How ever: despite the well demonstrated results of BYRD [14] and GODINA [15] an d because of the debridement concept and logistical insufficiencies, thorou gh treatment in a true emergency has not achieved full acceptance. In gener al, the majority of surgeons first clear, stabilize with the use of an exte rnal fixator in true emergency situations and cover several days later. For the past ten years, in real emergencies, in the Department of Orthopedics Traumatology and Plastic Surgery at the Besancon University Hospital Center we have subscribed to a radical treatment which simultaneously combines de bridement, osteosynthesis (locked centro-medullary nailing) and cover with the use of free flaps in the same operating period. A study based on 27 wou nded patients seeks to validate the advantages of looked centro-medullary n ailing over the use of an external fixator and the use of free flaps rather than local flaps in the most serious cases.