title: Soft-tissue coverage and outcome of gustilo grade IIIB midshaft tibia fractures: a 15-year experience.
abstract: BACKGROUND
  The authors describe a 15-year experience with Gustilo grade IIIB fractures of the midtibia based on the type and timing of soft-tissue coverage.
  
  
  METHODS
  A retrospective chart review was performed and patient demographics, risk factors, choice and timing of coverage, fracture outcome, and limb survival data were collected.
  
  
  RESULTS
  Sixty-five fractures were treated. Soft tissue coverage was performed either acutely [<1 week (48 percent)] or delayed [>1 week (52 percent); with either a soleus muscle flap [group A; n = 25 (38 percent)] or a free tissue transfer [group B; n = 40 (62 percent)]. In group A, 17 (68 percent) were performed acutely (subgroup A1) and eight (32 percent) were delayed (subgroup A2). In subgroup A1, eight (47 percent) had uncomplicated healing, whereas seven (41 percent) ended in nonunion. In subgroup A2, all eight patients went onto nonunion. The overall limb survival rate for group A was 92 percent (n = 23). In group B, 14 (35 percent) were performed acutely (subgroup B1) and 26 (65 percent) were delayed (subgroup B2). In subgroup B1, six (43 percent) had uncomplicated healing, and six (43 percent) ended in nonunion. In subgroup B2, six (23 percent) healed primarily, and 17 (65 percent) went onto nonunion. The overall limb survival rate for group B was 88 percent (n = 45).
  
  
  CONCLUSIONS
  Soft-tissue coverage is not the only determinant for successful outcome. Delayed coverage resulted in higher nonunion rates. Despite high nonunion rates, 89 percent of fractures ultimately healed successfully.
authors.affiliation: Minneapolis and Rochester, Minn. From the Division of Plastic Surgery, University of Minnesota, and the Division of Plastic Surgery, Mayo Clinic.
authors.forename: Umar
authors.initials: U
authors.lastname: Choudry
authors.forename: Steven
authors.initials: S
authors.lastname: Moran
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Karacor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002648:Child; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D055815:Young Adult