Once the wound is debrided well and the fractures are stabilized it is important to achieve soft tissue cover as early as possible.  Bone without periosteum, tendons without paratenon and nerves if left to dry, die. Achieving definitive cover within 48 hours should be the aim and definitely it should be done within 5 days.

THE TYPE OF WOUND COVER

Bone without periosteum and tendons without paratenon will not accept skin graft and need flap cover.  It is not the size of the wound that determines whether the wound needs a flap or a skin graft.  Rather it is the nature of the wound that determines if a flap is required.  The size of the defect only determines the type of flap used.  Underestimating the need for a flap cover, because the wound appears to be deceptively small is one of the commonest causes for wound break down and infection. 
 
 

.