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Early Flap Reconstruction and Infection Rates in Open Lower Extremity Fractures: A Systematic Review and

Rafael Felix P Tiongco¹, Siam K Rezwan¹, Sami Alahmadi²

¹From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Plastic and Reconstructive Surgery. Global Open

|June 9, 2025

Summary

This summary is machine-generated.

Timely flap coverage for severe open lower extremity fractures significantly reduces infection risk. Performing reconstruction within 72 hours of injury lowers complication rates, improving outcomes for patients with traumatic leg injuries.

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Area of Science:

Orthopedic Surgery
Trauma Reconstruction
Microsurgery

Background:

Severe open lower extremity fractures necessitate flap coverage for soft tissue reconstruction.
Infection is a frequent complication, leading to extended hospital stays, increased costs, and diminished patient outcomes.
The optimal timing for flap coverage to mitigate infection risk remains uncertain.

Purpose of the Study:

To review existing literature on flap coverage for lower extremity fractures.
To determine the association between the time to flap coverage and postoperative infection rates.

Main Methods:

A systematic literature search was conducted across 5 databases (up to March 2023).
Included studies involved 10+ patients with open lower extremity fractures undergoing flap reconstruction.
Meta-analyses compared outcomes for flap coverage within 72 hours and 7 days versus later intervals.

Main Results:

Sixteen studies encompassing 973 patients were analyzed.
Flap coverage within 72 hours correlated with a 52% reduction in infection and a 41% reduction in overall complications.
Coverage within 7 days showed a 50% reduction in infection but no significant decrease in total complications.

Conclusions:

Early flap coverage, specifically within 72 hours of injury, is associated with reduced infection rates.
This timely intervention is crucial for managing open lower extremity fractures and improving patient recovery.