title: Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis.
abstract: BACKGROUND
  Prolonged bed rest and elevation have traditionally been considered necessary after free-flap transfer to the lower extremities. In this retrospective study, we tried to mobilize patients early after free-flap transfer to the lower extremity by means of flow-through anastomosis for both arteries and veins.
  
  
  METHODS
  This study included 13 consecutive patients who underwent immediate free-flap transfer after wide resection of soft-tissue tumors of the lower extremity from March 2012 through July 2013. The defects were above the knee in 5 patients and below the knee in 8 patients. In all patients, flow-through anastomosis was used for both arteries and veins. The patients were mobilized starting on the first postoperative day, and their activities of daily life were gradually expanded, depending on the wound conditions. Postoperative complications and the progression of their activities of daily life were investigated retrospectively.
  
  
  RESULTS
  No anastomotic failure or take back occurred. Partial flap necrosis occurred in 1 patient because of a poor perforator but was unrelated to early mobilization. All patients could move to wheelchairs on the first postoperative day. Within 1 week, 12 of 13 patients could start dangling and 10 of 13 patients could start ambulating.
  
  
  CONCLUSIONS
  This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kayano
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Chuman
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kawai
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan; and Division of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba