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Optimal Timing in Reconstruction for Traumatic Lower Extremity Injuries
Kimberly Khoo1, Matthew J Heron1, Lily R Mundy1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Clinics in Plastic Surgery
|May 23, 2026
Summary
Early soft tissue reconstruction for lower extremity injuries, ideally within 7 days, may reduce complications compared to the traditional 72-hour window. This optimizes patient outcomes and quality of life.
Area of Science:
- Orthopedic Surgery
- Wound Healing
- Trauma Care
Background:
- Open lower extremity injuries necessitate soft tissue reconstruction, posing risks like flap failure and infection.
- Complications negatively impact patient physical, psychological, and economic well-being.
- Traditional teaching advocates flap reconstruction within 72 hours to minimize adverse events.
Purpose of the Study:
- To evaluate the optimal timing for flap reconstruction in open lower extremity injuries.
- To compare outcomes of early flap coverage within 7 days versus the traditional 72-hour window.
Main Methods:
- Review of contemporary studies incorporating negative pressure wound therapy.
- Analysis of complication rates and patient outcomes based on flap reconstruction timing.
Main Results:
- Advances in negative pressure wound therapy suggest comparable outcomes for flap reconstruction within 7 days.
- The traditional 72-hour guideline may not be universally optimal.
Conclusions:
- Reconstruction within 7 days may offer comparable outcomes to the 72-hour window for lower extremity injuries.
- Barriers in the US include transfer delays and lack of national timing guidelines.
