Therapy Driven Protocol: Early Ambulation for Lower Extremity Grafts

Early postoperative (post-op) ambulation benefits burn survivors by expediting return to functional independence, preventing bedrest complications, and shortening hospital admissions. Despite published practice guidelines supporting early ambulation, significant variability in practice continues among burn centers, ranging between 0 and 14 days post-op. A 3-year retrospective review was completed of this 15 bed, adult verified burn center, to identify 149 patients who underwent split thickness skin graft (STSG) placement and/or Autologous Skin Cell Suspension (ASCS) application to their lower extremities (LE). Patients unable to ambulate at baseline or died during admission were excluded. LE involvement ranged from 1% to 28% TBSA (Median: 5%). Autograft placement included 83% meshed (1:1-3:1) STSG (n = 125), 14.8% ASCS (n = 22), and 1.3% sheet STSG (n = 2). Grafts crossed joints on 119 patients including the knee (n = 58), ankle (n = 57), and foot (n = 41). Initial ambulation occurred between postoperative day (POD) 1 and 3 (Avg 1.05) with gait distance ranging from 2 to 1500 ft (Avg 125.4 ft). Twelve patients experienced minor graft loss, which healed conservatively. Additional analysis compared patients with and without graft loss. There was no significance associated between initial POD ambulation and graft loss. However, graft loss was significantly association with history of stroke (P = .006), renal disorder (P = .012), and previous amputation (P = .006). These findings suggest that, within a structured protocol, early ambulation as soon as POD 1 may be safely implemented without increased graft loss risk. Incorporating standardized mobility protocols, including use of compression and individualized clinical assessment, may help reduce practice variability and support earlier functional recovery in burn survivors.