Perfusion Controlled Mobilization after Lower Extremity Free Flaps—Pushing the Limits of Time and Intensity

Dornseifer, Ulf; Kleeberger, Charlotte; Kargl, Lukas; Schönberger, Markus; Rohde, Daniel; Ninković, Milomir; Schilling, Arndt F.

doi:10.1055/s-0036-1594296

Cited by 9 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thereafter, venous pooling took over, resulting in a decrease of StO 2 [ 4 , 19 ]. In the current study, this increase was not observed and was more in line with the study of Dornseifer et al On POD 3 and 4, they observed this increase in StO 2 as well, but on POD 5 this effect disappeared [ 20 ]. Furthermore, the saturation values of the contralateral leg were lower during the entire measurement than the saturation values of the free flap.…”

Section: Discussionsupporting

confidence: 93%

“…In the studies of Dornseifer et al and Ridgway et al, the dangling time was set at five minutes per day (dangling period was POD 7 until discharge and POD 3 until POD 9, respectively). Both found a significantly higher minimum StO 2 every following POD [ 19 , 20 ]. This is comparable with the study of Kolbenschlag et al They started dangling at POD 6, three times per day for 5 min.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in this study only StO 2 values were measured. In related studies, the regional hemoglobin, oxy- and deoxyhemoglobin, blood flow and tissue hemoglobin index (THI) in the free flap were also measured [ 3 , 20 , 36 ]. Unfortunately, these parameters are not incorporated in the Foresight device.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Tissue Oximetry Changes during Postoperative Dangling in Lower Extremity Free Flap Reconstruction: A Pilot Study

Lindelauf

Rooij

Hartveld

et al. 2023

Life

View full text Add to dashboard Cite

Background: Lower extremity free flap dangling protocols are still widely practiced, despite a paucity of evidence for their use. This pilot study investigates the use of tissue oximetry to provide further insight into the physiological effect of postoperative dangling in lower limb free flap transfer. Methods: Ten patients undergoing lower extremity free flap reconstruction were included in this study. Free flap tissue oxygen saturation (StO2) was continuously measured using non-invasive near-infrared spectroscopy. Measurements were performed on the free flap and contralateral limb during dangling from postoperative day (POD) 7 until 11, according to the local dangling protocol. Results: StO2 values measured in the free flap diminished to 70 ± 13.7% during dangling. This minimum StO2 was reached significantly later, and correspondingly the area under the curve (AUC) was significantly larger on POD 11 compared to the start of the dangling protocol on POD 7, reflecting an improving free flap microvascular reactivity. The dangling slope was equal between the free flap and contralateral leg. The reperfusion slope was significantly flatter on POD 7 compared to the other PODs (p < 0.001). Thereafter, no significant differences between PODs were observed. Patients with a history of smoking had significantly lower tissue oximetry values compared to non-smokers. Conclusions: The application of tissue oximetry during dangling provides further insight into the physiological effect (i.e., changes in microcirculatory function) of the free flap of the reconstructed lower extremity. This information could potentially be useful to either revise or disrupt the use of such dangling protocols.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tissue Oximetry Changes during Postoperative Dangling in Lower Extremity Free Flap Reconstruction: A Pilot Study

Lindelauf

Rooij

Hartveld

et al. 2023

Life

View full text Add to dashboard Cite

show abstract

“…Decrease in postoperative oedema 20 and pain reduction during dangling 9 were reported. Near-infrared spectroscopy 9,19,22 and micro-dialysis monitoring 16 were used to measure flap perfusion parameters of compressed flaps during dangling, showing a lower drop in tissue oxygenation when compared to unwrapped limbs.…”

Section: Resultsmentioning

confidence: 99%

Safety and effectiveness of early compression of free flaps following lower limb reconstruction: A systematic review

Berner

Will

Geoghegan

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

View full text Add to dashboard Cite

Introduction: Early postoperative compression of free flaps for lower limb reconstruction remains controversial. It may reduce venous congestion and promote resolution of oedema. However, concerns remain regarding inadvertent pedicle compression, which may lead to flap failure. The aim of this systematic review was to determine the safety and effectiveness of this intervention. Methods: A systematic review was designed in compliance with PRISMA. MEDLINE and EMBASE databases were searched. Parallel screening, selection of eligible studies and data gathering was carried out by two independent authors. A formal risk of bias assessment was included along with appraisal of outcomes.Results: A total of 847 abstracts were retrieved and 262 free flaps for lower limb reconstruction were identified in 10 eligible articles. The overall flap failure rate for patients that underwent early postoperative compression was 1.6%. Apart from flap failure rates, there were no other outcomes consistently reported and none of the studies included a no-compression group for comparison. Discussion: All the included studies had methodological flaws, resulting in a high risk of bias.Nevertheless, there was consistent reporting of flap failure as a postoperative outcome. Compression of free flaps in the context of lower limb reconstruction does not appear to be associated with a higher flap failure rate compared with other series. Compression bandages may reduce the pain associated with dangling regimes. However, there is no evidence to support that free flap compression in the context of lower limb reconstruction is associated with any other clinical benefit.

show abstract

“…Dangling protocols vary widely in their length and their level of detail and prescriptiveness, with dangling regimes varying in length from as little as 1-2 days to as long as 12 days [1,7] . Some units have made their dangling protocols public and shown encouraging results that early weight-bearing protocols can improve standardization of care and reduce hospital stay without an increase in complications [23] . Other research efforts have examined the use of techniques such as compression dressings and tilt-tables to help "train" the flap to the conditions experienced in dependency [1,24] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes between early and delayed weight bearing following lower limb free flaps: an 18-month single-center study

Al-Khalil¹,

Roman²,

Emam³

et al. 2023

Plast Aesthet Res

View full text Add to dashboard Cite

Aim: Post-operative protocols following lower limb free flap surgery are not well defined, with a lack of consensus in the literature around limb dependency and weight bearing. The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling (day 3 vs. day 4) and weight bearing (day 5 vs. day 14) post lower limb free flap surgery. Methods: All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database. Patient data were collected from the comprehensive lower limb free flap database, medical notes, and electronic records. Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded. Results: A total of 37 patients, 15 pre- and 22 post-enhanced protocol, were identified for comparison. The mean age was 43 (17-72) with a M:F of 3:1. There was no difference in the type of flap reconstruction between groups, with the anterolateral thigh flap being the most common in both groups. No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol, with the mean length of stay reduced from 12.1 to 10.6 days (P = 0.34). Conclusion: The new enhanced protocol remains the standard of care in our unit, as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.

show abstract

Perfusion Controlled Mobilization after Lower Extremity Free Flaps—Pushing the Limits of Time and Intensity

Cited by 9 publications

References 19 publications

Tissue Oximetry Changes during Postoperative Dangling in Lower Extremity Free Flap Reconstruction: A Pilot Study

Tissue Oximetry Changes during Postoperative Dangling in Lower Extremity Free Flap Reconstruction: A Pilot Study

Safety and effectiveness of early compression of free flaps following lower limb reconstruction: A systematic review

Comparison of outcomes between early and delayed weight bearing following lower limb free flaps: an 18-month single-center study

Contact Info

Product

Resources

About