(iii) Soft-tissue reconstruction in open tibial fractures

Open long bone fractures are surgically challenging limb-threatening injuries. There are a variety of techniques to close a soft-tissue defect ranging from the occasionally used primary closure, through local skin and muscle flaps based on perforating vessels from axial named arteries to micro-vascular free-tissue transfer. While now an historical concept, the ‘Reconstructive Ladder’ is still relevant today. Angiography is of paramount importance and should be undertaken as a matter of routine when free-tissue transfer is considered.