Tibial fracture is an injury that occurs along the length of the bone between the ankle and the knee. This is usually as a result of intense trauma incurred in high falls or road accident. Its repair is complex due to corresponding lack of soft tissue coverage and the blood supply of the tibial. Open tibial fractures take approximately 9 months to join and can sometimes cause non-union complications. In this case bone repair is recommended.

Factors such as location, donor site, level of infection and size of the affected area are considered when planning for the soft tissue coverage procedure. To secure the fracture, techniques such as bone morphogenetic proteins are used as therapy. Orthopedic and plastic surgeons are the specialists that deal with the management of open tibial fractures.

Common Causes of Open Tibial Fractures

There are extreme factors which can cause open tibial fractures hence requiring repaire of the soft tissue. These include:

• Soft tissues and skeletal injury caused by close-range gunshot
• Injury from a road accident
• Occurrence of multiple fractures or dislocation
• Soft tissue avulsion
• Limb ischemia

Different Methods of Tissue Coverage of Open Fracture

Coverage of soft tissue and wound closure assists in restoration of perfusion (fluid passage in the lymphatic system) in the soft tissues and the injured bone. This avoids non-union of ischemia bone and post infectious diseases such as osteomyelitis.  The repair is done immediately after the fracture so that rigid stabilization is implemented.

The type of flap to be used is selected based on the defect of the tibia, and the availability of the coverage tissues. The type of flaps includes:

Muscle Flaps

Tibia fracture takes time to unite and the healing of the bone is enhanced by the use of a muscle flap coverage. Severe damage of soft tissue of open tibial fracture is repaired with the ‘fix and flap’ approach whereby debridement, rigid stabilization and consistent removal of the dead debris by using a well vascularized muscle flap.

Muscle flaps are efficient in promoting healing, have less necrosis rate and reducing the risk of infection.

Fasciocuteneous Flaps

Fasciocuteneous flaps are largely used in repairing open tibial fracture because of their efficiency, are readily available, are coherent and adaptable, which leads to a shorter healing process. The treatment of debridement and free anterolateral thigh flaps is used when repairing with fasciocuteneous flaps for open tibial fracture. This soft tissue flap enhances the appearance of the ankle level where the defect had occurred making it easier to reanalyze the bone grafting procedure.

Local fasciocuteneous flaps are used in definite coverage of soft tissues if it can accommodate the degloving and injury of the tibia. However, at times fasciocuteneous flaps may cause peripheral vascular disease which means that the artery wall is affected with plaque which decreases blood flow to the tissue.

Complications Involved in Soft Tissue Repair in Open Tibial Fracture

• Occurrence of comorbidities (presence of two or more diseases at ago in a person) which may lead to diabetes mellitus or peripheral vascular disease.
• High energy injury that may lead to amputation.
• Sepsis that occurs when the body does not respond to the infection-fighting process, and instead damages its own tissues.
• Necrosis which occurs when the body tissues die due to lack of enough blood supply to the tissues.
• Ulceration of the skin which occurs as a result of poor blood flow thus delaying the healing process.

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