A 25-year-old man with an open tibial fracture classified as Gustilo-Anderson IIIB is brought to the emergency department. After irrigation and debridement, which definitive soft tissue management is most appropriate for Gustilo IIIB?

• A Primary wound closure over a drain within 24 hours
• B Split skin grafting immediately after initial debridement
• C Wound left open, with repeat washout; flap coverage (local or free) within 72 hours to 7 days ✓
• D Vacuum-assisted closure (VAC) therapy for 6 weeks as definitive wound management

Explanation

Gustilo IIIB open fractures have massive periosteal stripping and bone exposure requiring flap coverage for wound closure. Primary closure is contraindicated due to contamination risk. Guidelines recommend leaving the wound open after initial debridement, repeated washouts at 48-hour intervals, and definitive flap coverage (local rotational or free tissue transfer) within 72 hours to 7 days (ideally within 72 hours per BOA/BAPRAS guidelines). VAC therapy is a bridging adjunct before flap coverage, not definitive management.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.