Canadian Postoperative Dependency Protocols Following Lower Limb Microvascular Reconstruction: A National Survey and...

Area of Science:

• Microsurgery
• Plastic Surgery
• Vascular Surgery

Background:

• Lower limb free tissue transfer presents challenges in flap survival due to edema and reduced perfusion post-surgery.
• Existing evidence is limited regarding optimal postoperative protocols for lower extremity dangle, monitoring, and anticoagulation.
• This study investigates current practices among Canadian microsurgeons for managing these critical postoperative aspects.

Purpose of the Study:

• To survey Canadian microsurgeons regarding their current postoperative dependency protocols for lower limb free tissue transfer.
• To identify trends and variations in flap monitoring, anticoagulation, and extremity dangle management.
• To highlight the need for standardized evidence-based guidelines.

Main Methods:

• An anonymous 17-question electronic survey was distributed to plastic surgeons at Canadian teaching institutions.
• The survey focused on postoperative management of lower limb free tissue transfer, including dependency protocols.
• A literature review supplemented the survey data to identify existing protocols and consensus opinions.

Main Results:

• All 16 respondents monitored flaps clinically; 13 used conventional Doppler.
• Fifteen respondents used anticoagulation, with aspirin and low-molecular-weight heparin being most common.
• Significant variability was observed in dependency protocols, with initiation ranging from postoperative day 3 to 10, and varied dangle durations and frequencies.

Conclusions:

• Canadian microsurgeons report high flap success rates (>90%) but lack consensus on postoperative dependency protocols.
• Current practices for flap monitoring, anticoagulation, and extremity dangle show considerable variation.
• Further randomized controlled trials are needed to establish optimal early, aggressive dependency protocols to potentially reduce length of stay and costs.