Principles of secondary soft tissue reconstruction after open fractures of the tibia

Course and prognosis of open lower leg fractures are significantly influenced by the concomitant soft tissue injury. Selection and timing of therapeutic procedures determine the final outcome. Fracture stabilisation takes priority. Early soft tissue coverage should be achieved by local cutaneous or fasciocutaneous flaps. Exposed bone can be covered by transposed local musculature. Especially in the distal third as well as in extensive soft tissue loss the microsurgical transplantation of free flaps is advantageous. Tissue expansion can provide skin for secondary replacement of instable scars.