Ignoring the need of soft tissue cover at the time of original injury is the commonest cause of a neglected wound.  Usually the wound is infected, edges are fibrosed and desiccated bone ends are visible in the wound.  This is an avoidable problem.  The first question that should be answered is whether to go ahead with reconstruction or suggest amputation.  It might appear crude but exhaustive attempts at salvage of a limb must not become a triumph of technique over reason.

The following will be the guiding factors in decision-making.  Upper limb wounds behave differently than lower limb wounds.  Blood supply is better in the upper limb than the lower limb, flap coverage is easier and bone union occurs earlier than lower limbs.  Further, reconstructed upper limbs function much better than any prosthesis.  When one approaches a neglected open fracture in the lower limb, reasonable chances of bony union must be present before starting the reconstructive process. Studies have shown that the chances of a person going in for gainful employment is very less if bone union has not occurred within 18 months.  In most of these patients many bridges have already been burnt and we cannot afford to do further mistakes.  If reasonable chances of bony union do not exist, it is prudent to go in for amputation and prosthesis fitting in the lower limb wounds.  It is much kinder to the patient than attempting lengthy reconstruction schedules which ultimately fail.
 
 

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