A Survey of U.K. Units and a Suggested Protocol for Free Flap Reconstruction of the Lower Limb: Follow-up and Management in the First Postoperative Week

ABSTRACT

A survey was performed of U.K. lower-limb reconstruction services and the protocol for management of free flaps to the lower limb in the first postoperative week. The postoperative period is of vital importance in these patients due to the complex nature of microsurgical tissue transfer. A range of answers were received in response to the questions regarding protocols, with no overall consensus on the postoperative plan for these patients. Patients are being managed differently in different units across the United Kingdom. A protocol that has been used successfully by the senior author is described, and we encourage others without a protocol to adopt this one.

Lower limb - free flap - protocol

REFERENCES

• 1 Xipoleas G, Levine E, Silver L, Koch R M, Taub P J. A survey of microvascular protocols for lower extremity free tissue transfer II: postoperative care.  Ann Plast Surg. 2008;  61 280-284
• 2 Nygren J, Thorell A, Jacobsson H et al.. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration.  Ann Surg. 1995;  222 728-734
• 3 Nygren J, Soop M, Thorell A, Sree Nair K, Ljungqvist O. Preoperative oral carbohydrates and postoperative insulin resistance.  Clin Nutr. 1999;  18 117-120
• 4 Yuill K A, Richardson R A, Davidson H IM, Garden O J, Parks R W. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively—a randomised clinical trial.  Clin Nutr. 2005;  24 32-37
• 5 Rohde C, Howell B W, Buncke G M et al.. A recommended protocol for the immediate postoperative care of lower extremity free-flap reconstructions.  J Reconstr Microsurg. 2009;  25 15-19
• 6 Siemionow M, Arslan E. Ischemia/reperfusion injury: a review in relation to free tissue transfers.  Microsurgery. 2004;  24 468-475
• 7 Khiabani K T, Kerrigan C L. Differing flow patterns between ischemically challenged flap skin and flap skeletal muscle: implications for salvage regimens.  Plast Reconstr Surg. 2002;  109 220-227
• 8 Chen K T, Mardini S, Chuang D C et al.. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.  Plast Reconstr Surg. 2007;  120 187-195
• 9 Robless P, Okonko D, Mikhailidis D P, Stansby G. Dextran 40 reduces in vitro platelet aggregation in peripheral arterial disease.  Platelets. 2004;  15 215-222
• 10 Batlle J, del Río F, López Fernández M F, Martín R, López Borrasca A. Effect of dextran on factor VIII/von Willebrand factor structure and function.  Thromb Haemost. 1985;  54 697-699
• 11 Jallali N. Dextrans in microsurgery: a review.  Microsurgery. 2003;  23 78-80
• 12 Wright E, Khan U. C-Reactive Protein (CRP) Levels in Patients following Local and Free-Flap Reconstruction of the Lower Extremity for Trauma and Chronic Infections. Presentation at Winter BAPRAS at Royal College of Surgeons, London, December 3–5, 2008