Rethinking Dangling: Omission of Inpatient Dangle Protocols Shortens Hospital Stay Without Adverse Effects on Lower...

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Formal dangling protocols are standard post-lower extremity free flap reconstruction to manage gravitational stress.
• The clinical efficacy of these structured protocols remains uncertain.
• This study investigates the impact of formal dangling protocols on flap outcomes.

Purpose of the Study:

• To evaluate the effect of structured inpatient dangling protocols versus ad libitum dangling on free flap outcomes in lower extremity reconstruction.
• To determine if formal dangling protocols influence flap survival, complication rates, or hospital length of stay.

Main Methods:

• Retrospective review of 82 patients undergoing lower extremity free flap reconstruction (2015-2024).
• Patients grouped by adherence to a formal dangling protocol (≥3 supervised sessions post-op day 5) versus no protocol (ad libitum dangling from day 3).
• Outcomes analyzed: flap survival, complications, reoperation, ambulation time, length of stay. Statistical analysis included chi-squared, t-tests, and multivariable regression.

Main Results:

• No significant differences in flap survival (96.2% vs. 96.6%), partial necrosis (9.4% vs. 10.3%), or 30-day reoperation rates (3.4% vs. 7.5%) between groups.
• Formal dangling protocol use was not associated with reduced complication risk (OR=0.95, p=0.93).
• Adherence to a formal dangling protocol was independently associated with a significantly longer median hospital stay (3.0 days, p<0.01).

Conclusions:

• Formal dangling protocols do not enhance flap survival or decrease complications in lower extremity free flap reconstruction.
• Structured dangling regimens are associated with prolonged hospitalization.
• Findings suggest that patient-tailored postoperative strategies may be more beneficial for recovery without compromising surgical success.