Early Initiation of Dangle Protocol in Lower Extremity Free Flap Microsurgery

Area of Science:

• Plastic Surgery
• Orthopedic Surgery
• Microsurgery

Background:

• Lower extremity defects frequently necessitate free tissue transfer for reconstruction.
• Postoperative dangle protocols are standard to acclimate flaps to venous pressure.
• The study investigates the impact of early dangle initiation on patient outcomes.

Purpose of the Study:

• To assess the safety of early dangle protocol initiation.
• To evaluate the effect of early dangle on postoperative length of stay.
• To compare outcomes between early and late dangle groups in lower extremity reconstruction.

Main Methods:

• Retrospective review of 83 patients undergoing lower extremity free tissue transfer (2012-2022).
• Patients divided into early (≤5 days) and late (>6 days) dangle groups.
• Statistical analyses (univariate and multivariate) performed with p < 0.05 significance.

Main Results:

• Early dangle (n=22) vs. late dangle (n=61) showed similar flap survival rates (90.9% vs. 90.2%).
• Mean postoperative length of stay was significantly shorter in the early group (12.3 days) compared to the late group (18.8 days; p=0.0018).
• No significant differences in wound healing complications, flap failure, or amputation rates were observed between groups.

Conclusions:

• Early dangle protocol initiation is safe and does not compromise surgical outcomes in lower extremity free tissue transfer.
• Implementing an early dangle protocol can significantly reduce postoperative length of stay.
• Findings support evidence-based recommendations for optimizing flap management and patient recovery.