Purpose. The immediate post-operative management of patients who undergo lower limb microsurgical reconstruction is often case and clinician based. The use of compression and introduction of gravity dependant conditioning - ‘wrapping and dangling’ - in the post-operative period are employed by most microsurgical centres, however a consensus on an optimal protocol is yet to exist. The timing and sequence of post-operative protocols has been speculated to impact outcomes in terms of wound healing, flap loss, function, and aesthetics. However, delay in initiation of wrapping and dangling can prolong hospital stay and patient immobilisation, thereby increasing hospital-related complications such as pneumonia, venous thrombo-embolism, and pressure injuries
Methodology. Retrospective analysis of single centre post-operative management of lower limb microsurgical reconstruction from consecutive cases between 2019 and 2020. Patient demographics, mechanism of injury, orthopaedic fixation, flap used, time to initiate wrapping and dangling, flap outcome, length of stay and complications were attained from hospital records
Results. 33 patients (34 flaps) underwent microvascular reconstruction of the lower limb. Most cases were for trauma (22), with the remainder comprising of oncology (7) and infection (4). Patients who had an unexpected return to theatre within the first 5 days were excluded from the study. Average time for commencement of compression was 6.4 days, with initiation of gravity dependant positioning at 7.1 days. There was no significant difference between fasciocutaneous and muscle flaps. Clinical monitoring and doppler ultrasound were for flap monitoring
Conclusion. Lack of a defined department-wide protocol for wrapping and dangling can delay patient discharge and lead to complications for both the patient and healthcare system. Unfamiliarity among allied health and junior staff with post-operative management can be a contributing factor. Herein we propose a streamlined protocol for both fasciocutaneous and muscle free flaps in lower limb reconstruction with the aim to educate junior staff