Presented at the 56th Annual Meeting California Society of Plastic Surgeons, Las Vegas, Nevada, June 2006.
The timing of microsurgical reconstruction in lower extremity trauma†
Article first published online: 8 OCT 2008
Copyright © 2008 Wiley-Liss, Inc.
Special Issue: Harry J. Buncke Special Issue
Volume 28, Issue 8, pages 632–634, 2008
How to Cite
Karanas, Y. L., Nigriny, J. and Chang, J. (2008), The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery, 28: 632–634. doi: 10.1002/micr.20551
- Issue published online: 3 NOV 2008
- Article first published online: 8 OCT 2008
- Manuscript Accepted: 2 JUL 2008
- Manuscript Received: 23 MAR 2008
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. © 2008 Wiley-Liss, Inc. Microsurgery, 2008.