Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

P.A. Ivanov1, E.U. Shibaev2, A.V. Nevedrov1, *, A.P. Vlasov2, M.P. Lasarev2
1 Sklifosovsky Clinical and Research Institute for Emergency Medicine, Polytrauma Department, Moscow, Russia
2 Sklifosovsky Clinical and Research Institute for Emergency Medicine, Emergency Reconctructive and Plastic Surgery Department, Moscow, Russia

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© Ivanov et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Sklifosovsky Clinical and Research Institute for Emergency Medicine 3, Bolshaya Sukharevskay sq. Moscow, 129010 Russia; Tel; +79252386348; E-mail:



Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people’s unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation.

The Aim of Study:

is to develop exact, usable and in practice algorithm of emergency reconstruction of leg soft tissues in patients with severe open tibia fractures, based on the usage of the most foolproof and simple methods.

Data (Patients) and Methods:

85 patients with open tibia fractures complicated by soft tissue defects were included in our study. Patients were divided into two groups. The control group consisted of 56 patients. Soft tissue reconstruction in this group was provided without an exact algorithm, after continuous attempts on local healing. After analyzing the treatment process and the treatment results we have developed the algorithm of emergency soft tissue reconstruction. It was used in 29 patients (the study group). This algorithm allows choosing optimal timing for tissue reconstruction and appropriate method to be applied, depending on the patient’s condition, the mechanism of soft tissue defect formation, and its square and localization.


We observed a statistical decrease in deep wound infection frequency, partial tibia necrosis frequency, chronic osteomyelitis frequency, duration of hospitalization in patients with severe open tibia fractures because of using our algorithm.

Keywords: Algorithm of emergency soft tissues reconstruction, Bone necrosis prevention, Local and free flap, Polytrauma, Severe open tibia fractures, Treatment result.