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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(02): e121-e128
DOI: 10.1055/a-2434-7478
Original Article

Postoperative Protocols for Lower Extremity Free Flap Reconstructions: Literature Review and a National Survey of the United Kingdom's Major Trauma Centers

Sevasti Panagiota Glynou   *
1   Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
2   Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
,
Ariadni Georgiannakis   *
1   Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
,
Edward Ackling
3   London Reconstructive Microsurgery Unit (LMRU), Department of Plastic and Reconstructive Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Nicola Bystrzonowski
3   London Reconstructive Microsurgery Unit (LMRU), Department of Plastic and Reconstructive Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Georgios Pafitanis
3   London Reconstructive Microsurgery Unit (LMRU), Department of Plastic and Reconstructive Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Andrew Diver
3   London Reconstructive Microsurgery Unit (LMRU), Department of Plastic and Reconstructive Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
› Author Affiliations Funding None.
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Abstract

Background Evidence for postoperative care of lower extremity free flap reconstruction (LEFF) varies and is yet to be standardized, despite established guidelines by the British Orthopedic Association Standard for Trauma (BOAST-4). This study assesses postoperative protocols for LEFF clinical monitoring, warming, dangling, and compression in the United Kingdom's (UK) major trauma centers (MTCs).

Methods An online questionnaire was distributed to consultant leads of all UK adult MTCs. Data requested the existence of a standardized protocol, intensity, and takeback of LEFF procedures and specific practices in clinical monitoring, warming, dangling, and compression. Analysis was performed in Excel.

Results The survey was returned by 23 (79.3%) units and most (86.9%) had standardized LEFF monitoring protocols. Centers typically performed four to eight surgeries monthly and on average had 2.7 salvageable LEFFs in 2022. Clinical monitoring was common (>92%) and included color, capillary refill, and temperature assessment. Compression initiation varied between 45.5% (starting after day 7) and 40.9% (from days 3 to 5). Continuous compression was favored (78.3%), using pillows (88.9%). Dangling protocols begin between days 3 and 7, for 5 minutes (52.2%) with frequencies of three to four times daily (25–37.5%). The preferred tool for LEFF warming was the Bair hugger (82.6%) and the mean termination day for warming was 3.61.

Conclusion The survey highlights the need for evidence-based and consensus in UK MTC protocols for LEFFs. We encourage ongoing research and collaborative efforts in creating an accepted protocol among MTCs that could be incorporated into the BOAST-4 guidelines for postoperative care standardization and improved patient outcomes.

Keywords

lower extremity - free flap - major trauma - protocol

Previous Presentation

This work was presented as an oral presentation at BLRS on March 23, 2023, in Belfast.


* These authors are the first coauthors.


Supplementary Material



Publication History

Received: 10 June 2024

Accepted: 30 September 2024

Accepted Manuscript online:
22 October 2024

Article published online:
13 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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