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Meta-analysis of Timing for Microsurgical Free-Flap Reconstruction for Lower Limb Injury: Evaluation of the Godina Principles.

Publication ,  Journal Article
Haykal, S; Roy, M; Patel, A
Published in: J Reconstr Microsurg
May 2018

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.

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Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

May 2018

Volume

34

Issue

4

Start / End Page

277 / 292

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgery
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Microsurgery
  • Length of Stay
  • Leg Injuries
  • Humans
  • Graft Survival
 

Citation

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Haykal, S., Roy, M., & Patel, A. (2018). Meta-analysis of Timing for Microsurgical Free-Flap Reconstruction for Lower Limb Injury: Evaluation of the Godina Principles. J Reconstr Microsurg, 34(4), 277–292. https://doi.org/10.1055/s-0037-1621724
Haykal, Siba, Mélissa Roy, and Ashit Patel. “Meta-analysis of Timing for Microsurgical Free-Flap Reconstruction for Lower Limb Injury: Evaluation of the Godina Principles.J Reconstr Microsurg 34, no. 4 (May 2018): 277–92. https://doi.org/10.1055/s-0037-1621724.
Haykal, Siba, et al. “Meta-analysis of Timing for Microsurgical Free-Flap Reconstruction for Lower Limb Injury: Evaluation of the Godina Principles.J Reconstr Microsurg, vol. 34, no. 4, May 2018, pp. 277–92. Pubmed, doi:10.1055/s-0037-1621724.
Journal cover image

Published In

J Reconstr Microsurg

DOI

EISSN

1098-8947

Publication Date

May 2018

Volume

34

Issue

4

Start / End Page

277 / 292

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgery
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Microsurgery
  • Length of Stay
  • Leg Injuries
  • Humans
  • Graft Survival