Objectives: Delayed coverage (>7 days from injury) of severe lower extremity fractures historically resulted in high complication rates. We studied whether delaying soft tissue coverage > 7 days resulted in greater flap related complications (flap loss and infections) and non-union.

Methods: We reviewed 30 consecutive free flaps for lower extremity open fractures. Group 1 had soft tissue coverage within 7 days of injury (n=13). Group 2 had coverage > 7 days after injury (n=17). We studied the number of debridements prior to coverage, time to coverage, flap related complications, and non-union.

Results: Group 1 had coverage 5 days earlier than Group 2 (median 6 d vs. 11 d). Group 1 underwent 50% fewer debridements than Group 2 (2 vs. 4, p< 0.05). There was no difference in flap related complications. Group 1 had one flap loss and no infections. Group 2 had two flap losses and one infection. There was no difference in rates of non-union between Groups 1 and 2 (31% vs. 6 %)

Conclusions: Delayed free flap coverage of severe lower extremity fractures was not associated with higher complication rates. Furthermore, our results suggest that a more debridements and delayed coverage results in higher rates of bone healing.