Soft-tissue coverage of the distal third of the leg and ankle.

The treatment of open fractures of the distal third of the leg and ankle region has evolved over the last decade and now focuses on debridement, skeletal stabilization, and free-tissue transfer to correct the soft-tissue deficits. Despite the application of microsurgical techniques, the management of these cases is still plagued by delayed union and nonunion, chronic, infection, and in the worst scenario, late amputation. Emphasis should now be shifted from soft-tissue cover and free-tissue transfer to the more global concept of total wound care and early return to function.