Total Contact Cast after Sole Free Flap Reconstruction for Early Ambulation

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Orthopedics

Background:

• Free flap reconstruction is a viable option for patients with chronic limb-threatening ischemia (CLTI).
• Early ambulation post-reconstruction can risk wound complications and prolonged hospitalization.
• Total contact cast (TCC) is effective for diabetic foot ulcers, promoting immobilization and off-loading.

Purpose of the Study:

• To evaluate the impact of postoperative Total Contact Cast (TCC) use on early limb loading.
• To assess the effect of TCC on hospital stay duration in CLTI patients undergoing free flap reconstruction.
• To compare wound healing outcomes between TCC and non-TCC groups in this patient population.

Main Methods:

• Retrospective analysis of CLTI patients who had free flap reconstruction from 2006-2023.
• Comparison of time to weight-bearing initiation between TCC (n=5) and non-TCC (n=7) groups.
• Assessment of wound dehiscence rates, ulcer presence at discharge, and average flap size.

Main Results:

• The TCC group initiated weight-bearing significantly earlier (19.8 days) than the non-TCC group (52.3 days).
• Wound dehiscence rates were lower in the TCC group (20%) compared to the non-TCC group (42.9%).
• Ulcer presence at discharge and average flap size did not show statistically significant differences between groups.

Conclusions:

• Postoperative TCC application may facilitate earlier weight-bearing after free flap reconstruction in CLTI patients.
• TCC shows a trend towards reduced wound complications, warranting further investigation.
• Larger-scale studies are necessary to confirm the benefits of TCC in this specific surgical context.