title: Early versus late flap coverage for open tibial fractures.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National University Hospital, Singapore.
authors.forename: Weiliang
authors.initials: W
authors.lastname: Chua
authors.forename: Soumen Das
authors.initials: SD
authors.lastname: De
authors.forename: Wong Keng
authors.initials: WK
authors.lastname: Lin
authors.forename: Fareed
authors.initials: F
authors.lastname: Kagda
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Murphy
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors
keywords: surgical flaps; tibial fractures; wound infection