The treatment of soft-tissue defects of the lower leg after a traumatic open tibial fracture

The treatment of large soft-tissue defects of the lower leg remains a challenge. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage still remains under discussion. Fifty-two patients were treated with local or free flap coverage after a traumatic soft-tissue defect of the lower leg. We compared the results after treatment with local versus free flaps and fasciocutaneous flaps versus musculocutaneous flaps. In the case of primary reconstruction, we also compared the results regarding the timing of the operation: patients treated within 72 h after the trauma versus patients treated after 72 h. Thirty-five patients (67%) have been treated because of posttraumatic soft-tissue defects and, therefore, insufficient fracture coverage. Seventeen patients (33%) were treated because of a chronic osteomyelitis that arose after the trauma. In our study, we did not find a statistically significant difference between the postoperative complications of local and free flaps. A significant increase could be demonstrated in the number of revisions after treatment with a free flap. Treatment with a fasciocutaneous flap in the entire study group was associated with significantly more postoperative complications than treatment with a musculocutaneous flap. There was no significant difference in results after early or late flap coverage. Patients treated with local or free flaps achieved equal outcomes, except for the number of postoperative revisions in which local flaps required lesser revisions. Treatment with a musculocutaneous flap is preferable to treatment with a fasciocutaneous flap regarding postoperative complications. The timing of operation proved not to be a discriminating factor.