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Dangle Protocols in Lower Extremity Reconstruction.

Z-Hye Lee¹, Elie P Ramly¹, Allyson R Alfonso¹

¹Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.

The Journal of Surgical Research

|May 14, 2021

Summary

This summary is machine-generated.

Postoperative dangling protocols after lower extremity microvascular reconstruction vary widely. Evidence suggests early dangling is safe, but protocols should be tailored to patient comorbidities and flap characteristics for optimal outcomes.

Keywords:

dangle protocol lower extremity free flap lower extremity reconstruction

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Area of Science:

Microsurgery
Plastic Surgery
Reconstructive Surgery

Background:

Dangling protocols after lower extremity microvascular reconstruction lack standardization, often relying on individual surgeon experience.
Existing protocols exhibit significant variability in initiation, duration, and frequency.

Purpose of the Study:

To conduct a systematic review to establish evidence-based recommendations for dangling protocols.
To consider patient-specific and flap-specific factors in developing these recommendations.

Main Methods:

A systematic review of PubMed, Embase-OVID, and Cochrane-CENTRAL was performed.
Data extracted included study design, patient/flap characteristics, protocol details, complications, and flap success rates.
Studies were assessed using the Oxford Center for Evidence-Based Medicine Levels of Evidence Scale.

Main Results:

Eleven articles (Level IIb-IV evidence) were included, with varying patient numbers and ages.
Flap success rates ranged from 94-100%, with early dangling appearing safe across various flap types.
Patient comorbidities (smoking, diabetes, hypertension) and flap characteristics (axial fasciocutaneous vs. muscular, venous anastomoses) influence tolerance.

Conclusions:

Heterogeneity in dangling protocols persists, highlighting the need for individualized approaches.
Patient comorbidities and flap characteristics are crucial factors in determining appropriate dangling protocols.
Standardized pathways based on risk factors are proposed, emphasizing clinical vigilance in tailoring protocols.