The soft tissue management of children's open tibial fractures.

A series of 49 children admitted with a diagnosis of open tibial fracture was reviewed with particular regard to soft tissue management. Injuries were grouped according to the Gustilo classification. Twenty-two patients had Grade I fractures, 11 Grade II and 16 Grade III (4 Grade IIIa, 11 Grade IIIb and one Grade IIIc). Patients were managed by early lavage and debridement under general anaesthesia, followed by immobilisation. Local transposition flaps were utilised in 10 patients and provided reliable soft tissue cover. A free tissue transfer was performed in only one patient. Complications appeared to be associated with delayed involvement by plastic surgeons.