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Does an Early and Aggressive Combined Wrapping and Dangling Procedure Affect the Clinical Outcome of Lower Extremity
Nils Neubert1, P M Vogt1, M May2
1Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
Journal of Reconstructive Microsurgery
|December 18, 2015
Summary
An early start to flap training (FT) using wrapping and dangling methods does not compromise flap perfusion, as confirmed by microdialysis. This early FT approach may also reduce hospital stays and associated risks like deep vein thrombosis.
Area of Science:
- Microsurgery
- Vascular Surgery
- Tissue Engineering
Background:
- The optimal timing for initiating flap training (FT) with combined wrapping and dangling techniques remains debated.
- Current evidence regarding flap compromise due to FT is limited, with many centers relying on established protocols.
Purpose of the Study:
- To investigate whether an early and aggressive FT protocol could induce metabolic changes indicative of ischemia and compromised flap perfusion.
- To assess flap viability using microdialysis to detect ischemia-induced metabolic alterations.
Main Methods:
- A randomized study involving 49 patients undergoing microvascular free flap reconstruction of the lower limb.
- Two groups were compared: Group I started FT on postoperative day 7, while Group II commenced on day 3.
- Flap monitoring included clinical assessment and microdialysis to evaluate metabolic parameters and ischemia indicators.
Main Results:
- All patients completed the FT protocol without complications, demonstrating the safety of both early and late initiation.
- Microdialysis revealed no significant differences in metabolic parameters between the early and late FT groups.
- Noninferiority of the early FT group was established, indicating comparable flap perfusion.
Conclusions:
- An early initiation of FT does not negatively impact flap perfusion, as evidenced by microdialysis.
- Early FT may contribute to a shorter hospital stay.
- Earlier mobilization associated with early FT could potentially reduce risks of deep vein thrombosis, pulmonary embolism, and pneumonia.
