Pre-tibial skin tears

• Blood supply is from proximal
• Length of the wound is inversely related to healing time
• Split skin grafting for coverage of the apex has been shown to improve healing time in an RCT (13 vs 40 days), decrease proportion of wounds not covered at 10 days (0% vs 26%), reduces need for further operation (0 vs 4)

Proximally based flap:

• Has a chance of healing, but is often crushed and poorly vascularised at apex
• Need to infiltrate local, clean the wound, excise any dead tissue, then loosely suture the angles at the base of the flap
• Often this can do quite well with a split-thickness skin graft to replace the apical part, if the apical part has to be debrided
• Alternatively, you may be able to save the apical portion of the flap if it looks ok, and especially if you debride the subcutaneous tissue

Distally based flap:

• Generally, these do quite poorly, because the blood supply is normally from proximal