Microvascular soft tissue reconstruction for acute tibial fractures--late complications and the role of bone grafting.

Forty-three patients underwent microvascular free flap reconstruction of severe acute compound tibial fractures between 1980 and 1987. Thirty-three patients with follow-up of one to three years were retrospectively reviewed. Time to bone union took an average of 37 weeks; 30% developed infection necessitating bone removal, and 2 patients required amputation for infected nonunion. Infection rates were lower for the free muscle flaps than for the free skin flaps. No correlation was drawn with the type of fracture, but a delay in wound closure was associated with a higher infection rate. All adult patients required bone grafting, with the least infection seen with the free vascularized bone flaps. Immediate fresh bone grafting at the time of free flap reconstruction, compared with delayed bone grafting, showed no added risk of infection.