{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:35:41Z","timestamp":1792010141382,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To evaluate whether the timing of flap coverage following definitive fixation influences deep infection and nonunion in patients with Gustilo\u2010Anderson (GA) Type 3B and 3C open tibia fractures, accounting for flap method (local vs. free) and tissue type (muscle vs. fasciocutaneous).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective cohort study of patients with GA 3B and 3C tibia fractures treated at a Level I trauma center (2013\u20132022) with fracture fixation and soft\u2010tissue reconstruction. Primary outcomes were deep surgical site infection and nonunion, assessed by timing of flap coverage (\u2264\u200972 vs. >\u200972\u2009h), tissue type, and flap method.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Fifty\u2010one patients (52 extremities) met inclusion criteria. Deep infection was significantly higher after free (13\/30, 43%) versus local flaps (0\/22;\n p<\/jats:italic>\n \u2009<\u20090.001). There was a trend toward increased infection rates when coverage occurred >72\u2009h post\u2010fixation (9\/30, 30%) versus \u2264\u200972\u2009h (4\/22, 18%;\n p<\/jats:italic>\n \u2009=\u20090.33). Among free flaps, coverage \u2264\u200972\u2009h had fewer infections (4\/13, 31%) than coverage >\u200972\u2009h (9\/17, 53%;\n p<\/jats:italic>\n \u2009=\u20090.22). Tissue type and timing had no significant effect: muscle \u2264\u200972\u2009h (4\/20, 20%) vs. > 72\u2009h (8\/23, 35%;\n p<\/jats:italic>\n \u2009=\u20090.28); fasciocutaneous \u2264\u200972\u2009h (0\/2) vs. >\u200972\u2009h (1\/7, 14%;\n p<\/jats:italic>\n \u2009>\u20090.99). Nonunion was more common with free flaps (13\/30) than local flaps (2\/22;\n p<\/jats:italic>\n \u2009=\u20090.007). Free flaps placed \u2264 72\u2009h had fewer nonunions (4\/13, 31%) than those placed >\u200972\u2009h (9\/17, 53%;\n p<\/jats:italic>\n \u2009=\u20090.22).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Free flaps were associated with higher rates of deep infection and nonunion. Although not statistically significant, there was a trend toward increased complications with coverage >\u200972\u2009h, especially for free and muscle flaps.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/micr.70110","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T12:29:55Z","timestamp":1756988995000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Does the Timing, Type, and Method of Flap Coverage After Open Tibia Fracture Fixation Influence the Rate of Deep Infection?"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6009-8034","authenticated-orcid":false,"given":"Umar","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Walter Reed National Military Medical Center Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Gray","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senay","family":"Ghidei","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Inova Fairfax Medical Center Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Quigley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Inova Fairfax Medical Center Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Mehan","sequence":"additional","affiliation":[{"name":"Dominion Plastic Surgery Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl","family":"Johnson","sequence":"additional","affiliation":[{"name":"Dominion Plastic Surgery Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Blake","sequence":"additional","affiliation":[{"name":"Dominion Plastic Surgery Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Goch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Inova Fairfax Medical Center Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-4029","authenticated-orcid":false,"given":"Greg","family":"Gaski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Inova Fairfax Medical Center Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002509"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181d048b8"},{"key":"e_1_2_10_4_1","unstructured":"Centers for Disease Control and Prevention; National Healthcare Safety Network.2024.\u201cSurgical Site Infection Event (SSI).\u201dNHSN Procedure\u2010Associated Module SSI Events.https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/9pscssicurrent.pdf."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003927"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198309000-00008"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000001"},{"key":"e_1_2_10_8_1","first-page":"1316","article-title":"The Timing of Flap Coverage, Bone\u2010Grafting, and Intramedullary Nailing in Patients Who Have a Fracture of the Tibial Shaft With Extensive Soft\u2010Tissue Injury","volume":"73","author":"Fischer M. D.","year":"1991","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1384674"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620x.82b7.10482"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002582"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181b5a308"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002033"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1691785"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001190"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001434"},{"key":"e_1_2_10_17_1","first-page":"1681","article-title":"Short\u2010Term Wound Complications After Application of Flaps for Coverage of Traumatic Soft\u2010Tissue Defects About the Tibia: The Lower Extremity Assessment Project (LEAP) Study Group","volume":"82","author":"Pollak A. N.","year":"2000","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001025"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000168"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009934"}],"updated-by":[{"DOI":"10.1002\/micr.70279","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000}}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70110","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70110","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:27:46Z","timestamp":1786987666000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/micr.70110"],"URL":"https:\/\/doi.org\/10.1002\/micr.70110","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70110"}}