Godina revisited: a systematic review of traumatic lower extremity wound reconstruction timing

Abstract

Backround: Marko Godina suggested in 1986 that soft tissue coverage of traumatic extremity wounds within 72 h of injury optimizes outcomes. Decades later, these recommendations remain controversial.

Methods: We performed systematic review of the literature using keywords ‘free flap coverage’ OR ‘soft-tissue reconstruction’ AND ‘lower extremity trauma’ OR ‘tibial or fibular fractures’. Patients receiving free flap or local muscle or fascia flaps were included. Patients were divided into two groups, one receiving coverage within 72 h of injury (<72 h) and one after 72 h (>72 h). Primary outcome measures were partial and total flap loss, as well as infection. Use of negative pressure wound therapy (NPWT) was noted. Descriptive statistics were performed.

Results: Twenty-one publications from 1986 to 2015 were included. The <72 h group had 295 patients and the >72 h group 972 patient. Total flap failure rate was 1.4% if coverage was performed <72 h after injury and 8.8% if >72 h after injury. Partial flap failure rate was 0.4% if coverage was performed <72 h after injury and 1.8% if >72 h after injury. Infection rate was 7.7% if coverage was performed <72 h after injury and 11.6% if >72 h after injury. Among the 182 patients in the >72 h group receiving NPWT, total flap failure rate was 3.6% and total infection rate 7.3%.

Conclusions: Total and partial flap loss rates, as well as infection rates, were lower when coverage was performed within 72 h of injury. Supporting Godina’s recommendation, early soft tissue coverage may be beneficial when circumstances permit. NPWT may be useful when reconstruction is not feasible within 72 h.

Keywords:

• Lower extremity reconstruction
• free flap
• infection

Acknowledgements

We would like to thank April Adams for her help in preparation of the figures.

Disclosure statement

No potential conflict of interest was reported by the authors.