{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:26:55Z","timestamp":1789453615766,"version":"build-2803163510"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Background\u2003The timing of free flap reconstruction after lower extremity trauma has been a controversial debate since Marko Godina's original 72-hour recommendation. Recent advances in microsurgery warrant an evaluation of the optimal time to reconstruction.<\/jats:p><jats:p>\n               Methods\u2003The Nationwide Readmission Database (2014\u20132019) was used to identify patients undergoing free flap reconstruction after lower extremity trauma. Risk-adjusted statistical methods were used to identify optimal time where risk of infectious and microsurgical complications increase and to quantify the risk associated with time delays.<\/jats:p><jats:p>\n               Results\u2003A total of 1,030 patients undergoing reconstruction were identified. The mean time to flap coverage was 24.3 days. Thirty-three percent were performed within 72\u2009hours, 24% from 72\u2009hours to 10 days, 18% from 10 to 30 days, and 24% after 30 days. Flaps performed after 10 days were associated with increased risk of surgical site infection, osteomyelitis, and other wound complications, compared with those performed within 72\u2009hours. There was no increased risk in the period of 72\u2009hours to 10 days. Revision amputation and microsurgical complications were not increased after 10 days. The predicted optimal cutoff was 9.5 days for microsurgical complications and 14.5 days for infectious complications.<\/jats:p><jats:p>\n               Conclusion\u2003Advances in microsurgery may be responsible for extending the time in which definitive soft tissue coverage is required for wounds resulting from lower extremity trauma. Although it appears the original 72-hour time window can be safely extended, efforts should be made to refer patients to specialty limb salvage centers in a timely fashion.<\/jats:p>","DOI":"10.1055\/a-2404-7634","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T23:49:45Z","timestamp":1724802585000},"page":"469-477","source":"Crossref","is-referenced-by-count":9,"title":["The Godina Principle in the 21st Century: Free Flap Timing after Isolated Lower Extremity Trauma in a Retrospective National Cohort"],"prefix":"10.1055","volume":"41","author":[{"given":"Theodore E.","family":"Habarth-Morales","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison D.","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo J.","family":"Rios-Diaz","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn B.","family":"Broach","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Serletti","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa\u00efd C.","family":"Azoury","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L Scott","family":"Levin","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Stephen J.","family":"Kovach","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan A.","family":"Rhemtulla","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,10,23]]},"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":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/PRS.0000000000005955","article-title":"Timing of microsurgical reconstruction in lower extremity trauma: an update of the Godina paradigm","volume":"144","author":"Z-H Lee","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1055\/s-0040-1710358","article-title":"Risk factors for lower extremity amputation following attempted free flap limb salvage","volume":"36","author":"W Piwnica-Worms","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1007\/s00264-015-2712-z","article-title":"A review of forty five open tibial fractures covered with free flaps. 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