Abstract
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 language | English (US) |
|---|---|
| Pages (from-to) | 15-19 |
| Number of pages | 5 |
| Journal | Journal of Reconstructive Microsurgery |
| Volume | 25 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2009 |
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Keywords
- Dependency
- Free flap
- Lower extremity
- Protocol
ASJC Scopus subject areas
- Surgery
Cite this
A recommended protocol for the immediate postoperative care of lower extremity free-flap reconstructions. / Rohde, Christine; Howell, Brittny Williams; Buncke, Gregory M.; Gurtner, Geoffrey C.; Levin, L. Scott; Pu, Lee Li-Qun; Levine, Jamie P.
In: Journal of Reconstructive Microsurgery, Vol. 25, No. 1, 01.2009, p. 15-19.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A recommended protocol for the immediate postoperative care of lower extremity free-flap reconstructions
AU - Rohde, Christine
AU - Howell, Brittny Williams
AU - Buncke, Gregory M.
AU - Gurtner, Geoffrey C.
AU - Levin, L. Scott
AU - Pu, Lee Li-Qun
AU - Levine, Jamie P.
PY - 2009/1
Y1 - 2009/1
N2 - 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.
AB - 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.
KW - Dependency
KW - Free flap
KW - Lower extremity
KW - Protocol
UR - http://www.scopus.com/inward/record.url?scp=58149374180&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=58149374180&partnerID=8YFLogxK
U2 - 10.1055/s-0028-1090600
DO - 10.1055/s-0028-1090600
M3 - Article
VL - 25
SP - 15
EP - 19
JO - Journal of Reconstructive Microsurgery
JF - Journal of Reconstructive Microsurgery
SN - 0743-684X
IS - 1
ER -