Early Start of the Dangling Procedure in Lower Extremity Free Flap Reconstruction does not Affect the Clinical Outcome

Abstract

An early and aggressive start of a combined dangling/wrapping procedure does not compromise flap circulation and allows mobilizing patients after free flap transfer to the lower extremity at an early stage. This approach improves patient comfort, shortens the hospital stay, and therefore reduces socioeconomic costs.

Early Mobilization after Free-flap Transfer to the Lower Extremities

“…Jokuszies et al 27 have reported that the early and aggressive start of dangling on the third postoperative day does not compromise flap survival. Unlike us, however, they did not use flow-through anastomosis in any patient.…”

“…Wrapping lessens the degree of decrease in tissue oxygenation of the flap during dependency and lessens the duration of this decrease after the lower extremity is elevated again. 8 However, unlike Jokuszies et al, 27 we do not wrap the flap until the seventh postoperative day owing to concerns about the effects of compression on the vascular pedicle. We believe that wrapping is not needed in the acute phase for the flaps with flow-through anastomosis because of its aforementioned hemodynamic advantages; therefore, we start wrapping from the second postoperative week, mainly to prevent edema of the limb and the flap.…”

Early mobilizing and dangling of the lower leg after one-stage reconstruction of Achilles tendon and overlying tissue defect using an anterolateral thigh flap with vascularized fascia lata

“…recommended their lower-leg dangling protocol. In their report, they started dangling of the lower leg at three days postoperatively [ 18 ]. In addition, Miyamoto et al.…”

“…In their report, there was no differences in a survival rate between flap types. However, their cases did not include the cases who received tendon reconstruction using free flap transfer [ 18 , 19 ]. Early dangling of the lower leg is difficult after reconstruction of the tendon as in our cases.…”

“…Many authors have reported one-stage reconstruction of a composite defect of the Achilles tendon and soft tissue using a free flap [ 2–17 ]. Recently, early dangling of lower legs after free tissue transplantation for the reconstruction following tumor ablation has been recommended [ 18 , 19 ]. On the other hand, there are no guidelines or reports regarding when dangling of the affected lower leg should be allowed in cases of Achilles tendon reconstruction where the ankle joint cannot be moved immediately after surgery.…”