A REVIEW OF 45 OPEN TIBIAL FRACTURES COVERED WITH FREE FLAPS. ANALYSIS OF COMPLICATIONS, MICROBIOLOGY AND PROGNOSTIC FACTORS

Treatment of open fractures is complex and controversial.The purpose of the present study is to add evidence to the management of open tibial fractures, where tissue loss necessitates cover with a free flap. We identified factors that increase the risk of complications. We questioned whether early flap coverage improved the clinical outcome and whether we could improve our antibiotic treatment of open fractures. From 2002 to 2013 we treated 56 patients with an open tibial fracture covered with a free flap. We reviewed patient records and databases for type of trauma, smoking, time to tissue cover, infection, amputations, flap loss and union of fracture. We identified factors thatincrease the risk of complications. We analyzed the organisms cultured from open fractures to propose the optimal antibiotic prophylaxis.Follow-up was minimum one year. Primary outcome was infection, bacterial sensitivity pattern, amputation, flap failure and union of the fracture.When soft tissue cover was delayed beyond 7 days, ...