As the surgeon’s capability increased, in many big units like ours understanding and cooperation between the plastic and orthopedic surgeons increased.  Realization dawned that advances in skeletal fixation and advances in soft tissue coverage techniques had reached such an extent that one person cannot be a master of both.  Plastic surgeons were getting involved in the management of open fractures at the stage of debridement itself.  This increased their involvement in the care of the patient.  Opportunity afforded at the acute stage to assess the extent of the tissue damage, made the plastic surgeon judicious in the choice of the flap from tissues in the vicinity of the wound.  Advances in anesthesia and monitoring techniques allowed long surgical procedures to be performed in the acute stage. 
 

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