Primary flap coverage with internal fixation in severe open leg fractures: A case series on Gustilo grade III injuries

Abstract

BACKGROUND: This study presents our experience in managing 10 cases of open tibial fractures (Gustilo type IIIa or IIIb) through a single-stage surgical approach combining internal fixation and soft tissue coverage. MATERIALS AND METHODS: We conducted a prospective study including all patients with Gustilo type III open tibial fractures. Each case underwent comprehensive clinical and radiological assessment, including standard radiography and computed tomography angiography (CTA). Surgical management consisted of internal osteosynthesis with immediate soft tissue reconstruction using either pedicled fasciocutaneous or muscle flaps in a single operative session. RESULTS: The predominant etiology was road traffic accidents, with motorcyclists accounting for 80 % of cases. The mean patient age ranged from 18 to 45 years, and all patients were admitted within 6 h post-injury. Surgical intervention included aggressive wound debridement, vascular and nerve repair, definitive intramedullary nailing, and immediate flap coverage. Radiological bone union was achieved at a mean of 5 months postoperatively. DISCUSSION: The single-stage approach for open tibial fractures with concomitant soft tissue reconstruction demonstrated significant clinical and economic advantages. By eliminating the need for secondary procedures, this method reduced overall treatment duration, accelerated functional recovery, and minimized healthcare costs. The integration of fracture stabilization and soft tissue coverage in a single surgical session optimizes resource utilization while improving patient outcomes. CONCLUSION: Our findings suggest that single-stage surgical management of Gustilo type III open tibial fractures combining definitive fixation with immediate flap coverage is both clinically effective and cost-efficient. This approach enhances recovery times, reduces financial burdens, and represents a viable strategy for complex open fracture management.