Despite convincing data from Ljubljana, Yugoslavia 20 years ago, that emergency free tissue transfer for open fractures results in a low infection rate, shorter hospitalisation, decreased time for bone healing, and low incidence of flap failure, there are circumstances that preclude against immediate wound closure. The case for delayed wound closure is made based on several parameters that include: surgical team availability, the condition of a patient, and adequate informed consent. Delayed wound closure is the rule and emergency free tissue transfer is the exception, in major trauma centres around the world. There is a difference between immediate, delayed, and late coverage and these terms have yet to reach universal acceptance. The demographics of reconstructive surgery are changing in terms of surgeons having the skill sets, desires, and incentives to perform complex reconstruction for open fractures. This issue will perhaps be the most telling characteristic of what happens as we go forward into the future of trauma care and the timing of wound closure.

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