DIFFICULT problems of coverage frequently are presented by compound fractures of the tibia. War injuries from missiles make obvious the surface losses from the beginning. After débridement of the wounds and fixation of the extremities, surface coverages were variously effected1 at a later time, and the plan of attack was generally recognized and standardized. Civilian types of compound injuries of the tibia and adjacent soft parts have caused early and late morbidity. Since large sloughs, osteomyelitis, delayed union, prolonged hospitalization and eventual amputation are frequently seen, a critical review of management seems warranted.
The fracture of the lower part of the leg differs from other fractures. The tibia is a long bone covered over more than one third of its surface with a thin protection of skin, fat and fascia. The skin covering is subjected to frequent trauma but, being distally located, is poorly vascularized. The bone itself shares