Optimizing Postoperative Mobility: A Review of Enhanced Recovery after Surgery Protocols for Pedicled Flap-Based...

Area of Science:

• Reconstructive Surgery
• Surgical Oncology
• Pelvic Floor Reconstruction

Background:

• Pelvic defects require reconstruction due to oncological resection, infection, or trauma.
• Locoregional flap reconstruction is often necessary due to functional demands and infection risk.
• Standardized enhanced recovery after surgery (ERAS) protocols are lacking for pedicled flap pelvic/perineal reconstructions.

Purpose of the Study:

• To review and analyze existing postoperative mobility protocols for pedicled flap-based pelvic and perineal reconstructions.
• To identify variations in mobilization and sitting protocols across different flap types.
• To propose standardized ERAS guidelines for these complex reconstructions.

Main Methods:

• Systematic literature search of PubMed and Embase (Jan 2000-Jan 2025).
• Inclusion of studies reporting pedicled flap-based pelvic/perineal reconstruction (excluding single case reports).
• Extraction and categorization of data on postoperative mobility, drain management, discharge, and complications by flap donor site.

Main Results:

• 42 of 536 articles met inclusion criteria.
• Significant variation in remobilization and sitting protocols observed across flap types (e.g., VRAM, IAP, IPA, ALT, gracilis).
• Median out-of-bed mobilization ranged from 1 to 5 days; sitting initiation ranged from 2 to 15 days postoperatively.

Conclusions:

• Current practices for pelvic flap reconstruction lack standardized ERAS protocols.
• Early mobilization and graded sitting are advocated, challenging prolonged bed rest.
• Specific guidelines are proposed, including 1-2 days bed rest, early ambulation, and gradual sitting, with modifications for perineal flaps.