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Stepwise Adoption of a Postoperative ERAS Pathway in Microsurgical Lower Extremity Reconstruction: Faster Recovery
Juyoung Bae1, Yun Choi, Kyeong-Tae Lee
1Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea.
Plastic and Reconstructive Surgery
|March 10, 2026
Summary
Implementing an Enhanced Recovery After Surgery (ERAS) protocol for lower extremity microsurgery improves patient recovery. This approach reduces hospital stay and complications, making early recovery feasible and safe.
Area of Science:
- Microsurgery
- Orthopedic Surgery
- Surgical Oncology
Background:
- Lower extremity microsurgical reconstruction is often overlooked due to complication concerns.
- Early postoperative recovery protocols have not been widely applied in this area.
Purpose of the Study:
- To evaluate the feasibility and outcomes of implementing an Enhanced Recovery After Surgery (ERAS) protocol.
- To assess the impact of ERAS on recovery and complication rates in lower extremity microsurgery.
Main Methods:
- Retrospective review of 240 lower extremity free flap reconstructions (2020-2024).
- Patients categorized into pre-ERAS, transition, and ERAS cohorts.
- Compared postoperative course and complication rates, assessing ERAS association.
Main Results:
- ERAS protocol adoption reduced nil per os (NPO) duration, bed rest, and length of stay (LOS).
- Flap and donor-site complication rates significantly declined.
- ERAS implementation associated with shorter NPO, reduced bed rest, and no increased flap complications.
Conclusions:
- Stepwise ERAS protocol adoption is feasible and effective for lower extremity microsurgery.
- ERAS promotes early recovery without increasing complication risk.
- ERAS significantly reduced LOS, especially in less comorbid or oncologic reconstruction patients.
