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Canadian Trends in Free Flap Management for Microsurgical Lower Limb Reconstruction.
Michelle Bonapace-Potvin1, Alexander Govshievich1, Laurent Tessier1
1Université de Montréal Plastic Surgery Program, Montréal, Quebec, Canada.
Plastic Surgery (Oakville, Ont.)
|February 9, 2023
Summary
Canadian microsurgeons often lack specific perioperative protocols for free flaps in lower limb reconstruction. Most surgeons use venous couplers and initiate early dangling, but compressive garment use is limited, with practices influenced by experience rather than evidence.
Area of Science:
- Microsurgery
- Plastic Surgery
- Orthopedic Surgery
Background:
- Free tissue transfers are crucial for lower limb salvage, particularly after trauma or tumor removal.
- Optimal perioperative management protocols for these complex reconstructions are not standardized.
- Current practices among Canadian microsurgeons require assessment to identify trends and potential areas for improvement.
Purpose of the Study:
- To evaluate the current perioperative management strategies for free fasciocutaneous flaps in lower limb reconstruction among Canadian microsurgeons.
- To identify trends in flap mobilization, venous management, and thromboprophylaxis.
- To gauge surgeon satisfaction and willingness to adopt evidence-based practices.
Main Methods:
- An online questionnaire was distributed to 64 Canadian microsurgeons.
- The survey assessed perioperative management details, including dangling timing, venous coupler use, and compressive garment application.
- Data on the influence of training versus evidence and surgeon satisfaction were collected.
Main Results:
- A significant portion (57%) of respondents lacked a specific mobilization protocol.
- Dangling was typically initiated 5-6 days postoperatively, with similar durations.
- Venous couplers were widely used (85.7%), while compressive garment use varied.
- Management trends were primarily driven by personal experience (53.6%) over evidence-based medicine (7.1%).
Conclusions:
- Canadian microsurgeons frequently employ venous couplers and initiate early flap mobilization (dangling).
- The application of compressive garments remains inconsistent.
- Current practices are largely experience-based, highlighting a need for higher-level evidence to guide standardized perioperative care in lower limb free flap reconstruction.
