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To determine whether a defined approach for debridement of open tibia fractures would result in no change in reoperation rate, but reduce the need for flap coverage.Prospective cohort study.Academic Level 1 trauma center.A total of 66 patients with 68 open diaphyseal tibia fractures were included. Patients under the age of 18 and with orthopaedic trauma association open fracture classification (OTA-OFC) skin score of 3 were excluded.Debridement of the open fracture through direct extension of the traumatic wound or through a defined surgical interval.Number of operations. Need for soft-tissue transfer.A total of 47 patients had direct extension of the traumatic wound and 21 patients had a defined surgical approach. The groups had similar proportions of Gustilo–Anderson and OTA-OFC subtypes. The average number of surgeries, including index procedure, per patient was 1.96 in the direct extension group and 1.29 in the defined approach group (P = 0.026). Flap coverage was needed in 9 patients in the direct extension group and no patients in the defined approach group (P = 0.048).A defined surgical approach to the debridement of open tibia fractures is safe and may reduce the need for flap coverage in select patients.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.