{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:35:41Z","timestamp":1792010141402,"version":"4.4.0"},"reference-count":58,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Early soft tissue coverage of open lower extremity fractures within 72\u2009hours of injury leads to improved outcomes. Little is known about outcomes when definitive fixation is completed first. The purpose of this study is to quantify postoperative outcomes when soft tissue reconstruction is delayed until after definitive open reduction and internal fixation (ORIF) is completed.<\/jats:p><jats:p>\n          Methods\u2003An insurance claims database was queried for all patients with open lower extremity fractures between 2010 and 2020 who underwent free or axial flap reconstruction after ORIF. This cohort was stratified into three groups: reconstruction performed 0 to 3, 3 to 7, and 7+ days after ORIF. The primary outcome was 90-day complication and reoperation rates. Bivariate and multivariable regression of all-cause complications and reoperations was evaluated for time to flap as a risk factor.<\/jats:p><jats:p>\n          Results\u2003A total of 863 patients with open lower extremity fractures underwent ORIF prior to flap soft tissue reconstruction. In total, 145 (16.8%), 162 (18.8%), and 556 (64.4%) patients underwent soft tissue reconstruction 0 to 3 days, 4 to 7 days, and 7+ days after ORIF, respectively. The 90-day complication rate of surgical site infections ( SSI; 16.6%, 16,7%, 28.8%; p\u2009=\u20090.001) and acute osteomyelitis (5.5%, 6.2%, 27.7%; p\u2009&lt;\u20090.001) increased with delayed soft tissue reconstruction. Irrigation and debridement rates were directly related to time from ORIF to flap (33.8%, 51.9%, 61.9%; p\u2009&lt;\u20090.001). Hardware removal rates were significantly higher with delayed treatment (10.3%, 9.3%, 39.3%; p\u2009&lt;\u20090.001). The 0 to 3 day (odds ratio [OR]\u2009=\u20090.22; 95% confidence interval [CI]: 0.15, 0.32) and 4 to 7 day (OR\u2009=\u20090.26; 95% CI: 0.17, 0.40) groups showed protective factors against all-cause complications after bivariate and multivariate regression.<\/jats:p><jats:p>\n          Conclusion\u2003Early soft tissue reconstruction of open lower extremity fractures performed within 7 days of ORIF reduces complication rates and reduces the variability of complication rates including SSIs, acute osteomyelitis, and hardware failure.<\/jats:p>","DOI":"10.1055\/a-2273-4075","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:08:26Z","timestamp":1708560506000},"page":"648-656","source":"Crossref","is-referenced-by-count":14,"title":["The Continued Impact of Godina's Principles: Outcomes of Flap Coverage as a Function of Time After Definitive Fixation of Open Lower Extremity Fractures"],"prefix":"10.1055","volume":"40","author":[{"given":"Elliot L. H.","family":"Le","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin T.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Constantine","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Greyson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Iorio","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,3,26]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00006534-198609000-00001","article-title":"Early microsurgical reconstruction of complex trauma of the extremities","volume":"78","author":"M Godina","year":"1986","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1055\/s-0037-1621724","article-title":"Meta-analysis of timing for microsurgical free-flap reconstruction for lower limb injury: evaluation of the Godina principles","volume":"34","author":"S Haykal","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1055\/s-0037-1607348","article-title":"Godina's principles in the twenty-first century and the evolution of lower extremity trauma reconstruction","volume":"34","author":"D L Colen","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1302\/0301-620X.82B7.0820959","article-title":"Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia","volume":"82","author":"S Gopal","year":"2000","journal-title":"J Bone Joint Surg Br"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1093\/bmb\/ldab013","article-title":"Management of Gustilo-Anderson IIIB open tibial fractures in adults\u2014a systematic review","volume":"139","author":"A Myatt","year":"2021","journal-title":"Br Med Bull"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1302\/0301-620X.86B6.13400","article-title":"The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage","volume":"86","author":"S Gopal","year":"2004","journal-title":"J Bone Joint Surg Br"},{"issue":"178","key":"ref8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1097\/00003086-198309000-00008","article-title":"Primary versus delayed soft tissue coverage for severe open tibial fractures. 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