Lower infection rate in patients with early flap coverage of open tibial fractures: A single-center retrospective study.

Background: Open tibial fractures with soft tissue defect are associated with a high risk of complications, particularly infection and non-union, and may result in limb loss in an otherwise fit and healthy adult. The timing of flap coverage seems to be a critical component of post-operative outcomes. Hypothesis - We hypothesized that early coverage within a week would be associated with a lower rate of postoperative complications, particularly infections.

Materials and methods: In this retrospective study, all consecutive adult patients managed at a French level I trauma centre between 2010 and 2023 for an open tibia fracture requiring flap coverage and having at least 1 year follow-up were included. The collected complications were infection, aseptic or septic non-union, flap failure, and amputation. Subgroup analyses were conducted according to time to flap coverage (early coverage ≤7 days and delayed coverage >7 days) and according to the presence or absence of infection.

Results: A total of 35 patients (mean age 45 ± 17.3, range 18-81; 88.6% of males) were included for analysis. Overall, 16 patients (45.7%) had an infection, 8 patients (24.2%) had non-union, 5 patients (14.3%) had flap failure, and 3 patients (8.6%) had amputation. Of the 35 patients, 17 (48.6%) received early flap coverage while 18 (51.4%) had a delayed flap coverage. The proportion of infections was significantly higher in patients who received delayed flap coverage compare to those who underwent early coverage (72.2% vs. 17.6%, p < 0.05). All cases of flap failure and septic non-union occurred in patients with an infection (p < 0.05).

Discussion: The present study confirms that early flap coverage within a week is associated with a lower proportion of infection, a key determinant of treatment success. Rapid and coordinated management between orthopaedic and plastic surgeons remains essential to optimize outcomes and limit complications.

Level of evidence: IV; single-centre retrospective cohort study.