The timing of microsurgical reconstruction in lower extremity trauma.
The timing of post traumatic microsurgical lower extremity reconstruction was defined by Godina in 1986, with recommendations for flap coverage of Gustillo grade IIIb/c fractures within 72 hours of injury. Godina's study showed the highest risk of infection and flap loss in the delayed period (72 hours-90 days). Subsequent authors have also cited lower rates of flap loss and infection when repair was performed "early". However, the definition of "early" remains ambiguous. We hypothesized that definitive debridement with optimal dressing care, meticulous microsurgical treatment planning, and vessel anastomoses outside of the zone of injury would allow for delayed reconstruction with high success rates. A retrospective review of 14 lower extremity reconstructions with free flaps was undertaken over a 4-year period. All patients underwent reconstruction in the delayed (>72 hours) period. There were no flap losses and one case of late osteomyelitis. We conclude that lower extremity reconstruction can be performed safely and effectively in the "delayed" period to allow for wound debridement, stabilization of other injuries, and transfer to a microsurgical facility.
Division of Plastic Surgery, Santa Clara Valley Medical Center, San Jose, CA 95128, USA. yvonne.karanas@hhs.co.santa-clara.ca.us
Yvonne L
YL
Karanas
John
J
Nigriny
James
J
Chang
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000517:prevention & control; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult