OPTIMIZATION OF THE TIMING AND METHODS OF SOFT-TISSUE DEFECT CLOSURE IN OPEN TIBIAL FRACTURES AT HIGH RISK OF INFECTION

Abstract

Open tibial fractures with soft-tissue loss have a high risk of contamination, devascularization, deep infection, osteomyelitis, and nonunion. Successful reconstruction requires fracture stabilization and rapid restoration of a durable, vascularized soft-tissue envelope. Delayed coverage leaves bone, tendons, vessels, and implants exposed, increases wound manipulation, and may prolong inflammation and hospital treatment. However, closure performed before adequate debridement can retain necrotic tissue and microorganisms, producing early failure. The optimal strategy therefore requires coordinated assessment of defect size, level, vascular status, contamination, fracture stability, and donor-site availability. Available options include tension-free primary closure, local rotational or perforator flaps, muscle flaps, fasciocutaneous free flaps, and temporary dressings before definitive reconstruction. Current standards favor combined orthoplastic planning and early definitive coverage, yet delays remain common because of patient instability, transfer, operating capacity, or specialist availability. Determining appropriate timing and selecting the least morbid reliable method are essential for reducing infection and preserving limb function