Eighteen patients who sustained severe open leg fractures (Gustilo�s III) were treated in ALBasrah
General Hospital and Al-Sadder Teaching hospital between 2007 and 2008. They
were12 males and 6 females, average age were 25 years. Middle third fractures occurred in 8
cases (44.4%) and the comminuted geometry of fracture was in 14 patients (77.7%). All patients
were treated by meticulous wound excision with stabilization of fracture and then wound cover,
which is done early in 6 patients (before 7 days) and late in 12 patients (after 7 days). Local
muscle flap was done in 9 patients (50%), local fasciocutanous flap in 6 patients (33.3%) and
free flap in 3(16.7%). The complications occurs more in late local reconstruction as flap infection
in (55.5%), nonunion in (33.3%), flap necrosis in (22.2%) and osteomylitis in (33.3%) while in
early reconstruction it is found only (16.6%) as a complication of each of the above. In muscle
flap, flap infection found in (22.2%), flap necrosis in (11.1%) and nonunion in (22.2%) which was
lower than other type of reconstruction, the muscle flap was more reliable flap in early period of
reconstructions. In conclusion, primary reconstruction of Gustilo's type III open tibial fractures
had advantages compared with secondary reconstruction.