The management of open fractures of the lower limb remains a challenge for both orthopaedic surgeons and reconstructive plastic surgeons. In the United Kingdom, about 15 open tibia fractures (shaft, plateau, and pilon) are treated at the average district general hospital serving a population of 25 000 each year, compared with 73 closed tibia fractures.1

Historically, most knowledge has been based on experience rather than evidence, and management has mainly been the remit of orthopaedic surgeons.2 Nowadays, several disciplines are involved in care including orthopaedic surgeons, plastic reconstructive and aesthetic surgeons, infectious disease specialists, and physiotherapists.

Few data are available on morbidity and mortality after open fractures, but prognosis has improved with the advent of antibiotics and rigid fixation in the mid-1970s.3 4 Subsequently, effective debridement, microvascular surgical techniques, and stabilisation of these fractures has improved salvage.5 6 7 Because the management of bone defects (bone loss at the time …