Flap coverage within 8 days does not increase fracture-related infection risk: results of a protocol implementation in a developing country.

Introduction: Open tibia fractures that require a soft tissue flap for adequate coverage (Gustilo- Anderson IIIB) are a significant challenge for trauma units. The incidence of fracture-related infection (FRI) has been reported to range between 10% and 52%. Early antibiotic therapy, followed by surgical debridement and early soft tissue coverage, is considered a safe and effective treatment. Typically, the gold standard is the "fix and flap" approach. However, local circumstances can impact the feasibility of early flap coverage. This study aims to determine whether there is a safe window for soft tissue coverage when an immediate ortho-plastic approach is not available.

Materials and methods: In this retrospective analysis of a prospective cohort of 803 patients who sustained a tibia fracture and were treated in a level I trauma centre in a developing country, we describe a local protocol of management. Of all the patients, 61 met the inclusion criteria and were followed for at least 12 months after flap coverage. The primary outcome was the development of FRI.

Results: Patients who underwent flap surgery within 8 days of the fracture, following the local protocol, had a 12.5% infection rate.

Conclusions: Utilizing a standardized management protocol followed by soft tissue flap coverage performed within 8 days is safe and effective in reducing the risk of developing FRI in open tibia fractures GA IIIB.