Early Results of Primary Soft Tissue Coverage in Type III A and B open Fractures of Tibia

Abstract

Objective: To observe the outcome of primary (early) soft tissue coverage of type III open
fractures and develop a safe protocol for these injuries.
Material & Methods: A prospective study of 65 patients suffering from open fractures of tibia
Gustilo and Anderson type III A and B, treated with external fixation and primary soft tissue
coverage was carried out in the Department of Orthopedic Surgery, Services Hospital, Lahore
from February 2004 to June 2006. Motorcycle and automobile vs pedestrian accidents were the
commonest cause comprising 90% of the injuries encountered. Strict criteria for inclusion in the
study included debridement within 12 hours of injury, no sewage or organic contamination and
absence of peripheral vascular disease. Poly-trauma patients were excluded. In all patients
radical debridement and stabilization with mono-lateral AO external fixator was done within 12
hours, followed by primary soft tissue coverage.
Results: At mean follow-up of 9 months (7-11), the outcome was excellent in 86.7%, good in
6.4% and poor in 6.9%. A total of 16 complications occurred in 12 patients; superficial infections
occurred in 09, deep infections in 05 and 02 patients developed non-union requiring further
surgery.
Conclusion: Primary soft tissue coverage with the above indications optimizes the recovery of
the patients in terms of lesser soft tissue infections and bone non-union due to chronic
osteomyelitis.