title: Soft tissue reconstruction after compound tibial fracture: 235 cases over 12 years.
abstract: BACKGROUND
  Outcomes in management of compound tibial fractures are measured by the rate of infection and non-union. These are a function of many variables that interact in complex ways. Our aims are to describe changes in these injuries over the past decade, to determine which variables predict a poor outcome and to compare reconstructive options controlling for these variables.
  
  
  METHODS
  All compound tibial fractures reconstructed at the Princess Alexandra Hospital from 1999 to early 2009 were reviewed retrospectively. The remainder of 2009 and 2010 were reviewed prospectively. Data were collected from departmental audits, medical records and imaging.
  
  
  RESULTS
  251 flaps were performed in 235 patients. Reconstructions within one week declined after 2000, which correlated with increasing Negative Pressure Dressings use (R = 0.77). Free flap use increased though the incidence of distal fractures did not (R = 0.29). Muscle flaps were consistently preferred. Injuries with a poor outcome had a greater delay or failed soft tissue reconstruction. A poor outcome was more likely in patients with a contaminated distal fracture (p = 0.0038). Outcomes in muscle and fasciocutaneous flaps were not significantly different.
  
  
  CONCLUSIONS
  Compound tibial fracture management has evolved to temporary followed by definitive fixation. Free flap use has increased, particularly in diaphyseal injuries. Delays in reconstruction should prompt aggressive surgical management. Injuries at risk of a poor outcome can be further characterised as being distal and contaminated. Reconstructive surgeons should not be discouraged from using muscle flaps. A management algorithm based on the evidence provided is presented.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia. Electronic address: michaelwagels@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagels
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Dan
authors.initials: D
authors.lastname: Rowe
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Shireen
authors.initials: S
authors.lastname: Senewiratne
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Tavis
authors.initials: T
authors.lastname: Read
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Theile
mesh_terms: D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D054843:Negative-Pressure Wound Therapy / Q000379:methods; D011237:Predictive Value of Tests; D011793:Queensland; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: Compound; Flap; Fracture; Leg; Reconstruction; Tibial