If the wound is widely open, or tissue protection is necessary, some form of flap coverage will probably be necessary. A VAC can be used to reduce the size of an open wound and to promote granulation tissue. A clean granulating wound with a healthy viable base may be covered with a split-thickness skin graft. An alternative temporary dressing for an open wound is an impermeable adhesive drape to create a space (bead pouch) for antibiotic beads.
Closure with local, or free, flaps is often appropriate for larger and more complicated wounds, once the infection has been adequately cleared surgically.
It is important to close a complex wound as soon as is safe, rather than leave it open too long and risk secondary infection. The timing of these stages requires mature surgical judgment.