[Treatment of complex loss of substance in acute leg injuries]

Solving the problems inherent in the treatment of Gustillo type III open fractures of leg requires the intervention of multiple surgical disciplines: orthopedic, plastic and vascular. Consensus exists with respect to many therapeutic principles, but several points remain the subject of debate. Based on an extensive literature review, the indications, results and prognosis for both skin covery and bone reconstruction are defined as precisely as possible. Early treatment is essential, the loss of soft tissue substance being repaired within the first two weeks, particularly if the use of a free flap is envisaged. Two stage treatment, cutaneous and bony, offers the advantage of safety, with additional benefits if conventional grafts are applied within 1 to 2 months. Overall therapeutic results are dependent on good interdisciplinary team work and, to an increasing extent, on the urgent participation of plastic surgeons experienced in microsurgical techniques.