Abstract
Background In 1986, Marko Godina published his seminal work regarding the timing of free-flap
reconstruction for traumatic extremity defects. Early reconstruction, compared with
delayed and late reconstruction resulted in significant decreases in free-flap failure
rate, post-operative infections, hospitalization time, bone healing time, and number
of additional anesthesias. The objective of this manuscript was to evaluate whether
these principles continue to apply.
Methods A meta-analysis was performed analyzing articles from Medline, Embase, and Pubmed.
Four hundred and ninety-two articles were screened, and 134 articles were assessed
for eligibility. Following full-text review, 43 articles were included in this study.
Results The exact timing for free-flap reconstruction, free-flap failure rate, infection
rate, and follow-up was defined in all 43 articles. Early free-flap reconstruction
was found to have significantly lower rates of free-flap failure and infection in
comparison to delayed reconstruction (p = 0.008; p = 0.0004). Compared with late reconstruction, early reconstruction was found to have
significantly lower infection rates only (p = 0.01) with no difference in free-flap failures rates. Early reconstruction was
found to lead to fewer additional procedures (p = 0.03). No statistical significance was found for bone healing time or hospitalization
time.
Conclusion Early free-flap reconstruction performed within the first 72 hours resulted in a
decreased rate of free-flap failures, infection, and additional procedures with no
difference in other parameters. The largest majority of free flaps continue to be
performed in a delayed time frame.
Keywords
free flaps - lower limb injury - godina
