Soft tissue management of open tibia fractures.

In this article, we have outlined our treatment approach to severe open tibial fractures (Gustilo type III injuries). We believe that collaboration between the plastic surgeons and orthopedic surgeons will aid in minimizing complications and facilitate optimal rehabilitation. In our opinion, the treatment of these injuries is facilitated in trauma centers with the expertise to address the complicated issues surrounding bone and soft tissue management techniques. The fundamental concepts of our approach are adequate debridement and early bone fixation, followed by soft tissue closure with obliteration of all dead space. Bone defects are addressed 4 to 8 weeks following injury with cancellous bone grafts or vascularized fibula transfer. This protocol has been successful in virtually eliminating the problem of infection and in salvaging and rehabilitating severely injured extremities.