A recommended protocol for the immediate postoperative care of lower extremity free-flap reconstructions

Christine Rohde, Brittny Williams Howell, Gregory M. Buncke, Geoffrey C. Gurtner, L. Scott Levin, Lee Li-Qun Pu, Jamie P. Levine

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


The success of lower extremity microsurgical reconstructions may be compromised postoperatively secondary to several factors, including thrombosis, infection, bleeding, and edema. To address edema, surgeons may use protocols for gradually dangling and/or wrapping the affected extremity. Such protocols vary widely among surgeons and are typically based on training and/or prior experience. To that end, we distributed surveys to five plastic surgeons who are experienced in microvascular lower extremity reconstruction at five different institutions. The surveys inquired about postoperative management protocols for lower extremity free flaps with regard to positioning, compression, initiation and progression of postoperative mobilization, nonweightbearing and weightbearing ambulation, assessment of flap viability, and flap success rate. These protocols were then evaluated for similarities to create a consensus of postoperative management guidelines. Progressive periods of leg dependency and compression therapy emerged as important elements. Although the consensus protocol developed in this study is considered safe by each participant, we do not intend for these recommendations to serve as a standard of care, nor do we suggest that any one particular protocol leads to improved outcomes. However, these recommendations may serve as a guide for less experienced surgeons or those without a protocol in place.

Original languageEnglish (US)
Pages (from-to)15-19
Number of pages5
JournalJournal of Reconstructive Microsurgery
Issue number1
StatePublished - Jan 2009


  • Dependency
  • Free flap
  • Lower extremity
  • Protocol

ASJC Scopus subject areas

  • Surgery


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