title: Perfusion Controlled Mobilization after Lower Extremity Free Flaps-Pushing the Limits of Time and Intensity.
abstract: BackgroundThe current standard to gradually adapt the fragile perfusion in lower extremity free flaps to an upright posture is the dangling maneuver. This type of flap training neither fits the orthostatic target load of an upright posture, nor does it assist in mobilizing the patients effectively. In this study, we quantitatively analyzed training effects of an early and full mobilization on flap perfusion.MethodsA total of 15 patients with gracilis flaps for distal lower extremity reconstruction were included. Flap training was performed daily by mobilizing the patients on a tilt table into a fully upright posture for 5 minutes between the third and fifth postop days (PODs). Changes in micro- and macrocirculation were analyzed by laser Doppler flowmetry, remission spectroscopy, and an implanted Doppler probe.ResultsAll flaps healed without complications. Yet, in three patients, the increased orthostatic load required an adjustment of the training duration due to a critical blood flow. The others showed an increasing compensation in the microcirculation. When tilting the patients, blood flow and oxygen saturation dropped significantly less on POD5 than on POD3. Furthermore, a significant increase of the blood flow was noted after an initial decrease during the mobilization on all days. An increasing compensation in the macrocirculation could not be determined.ConclusionFull mobilization of patients with lower extremity free flaps can be performed safely under perfusion monitoring, already starting on POD3. Additionally, monitoring allows a consideration of the individual orthostatic competence and therefore, exploitation of the maximum mobilization potential.
authors.affiliation: Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Technische Universität München, Munich, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dornseifer
authors.affiliation: Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Technische Universität München, Munich, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kleeberger
authors.affiliation: Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Technische Universität München, Munich, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Kargl
authors.affiliation: Institute of Medical and Polymer Engineering, Technische Universität München, Garching, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Schönberger
authors.affiliation: Institute of Medical and Polymer Engineering, Technische Universität München, Garching, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rohde
authors.affiliation: Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Technische Universität München, Munich, Germany.
authors.forename: Milomir
authors.initials: M
authors.lastname: Ninkovic
authors.affiliation: Department of Experimental Plastic Surgery, Clinic for Plastic and Hand Surgery, Technische Universität München, Munich, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Schilling
mesh_terms: D004487:Edema / Q000517:prevention & control; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006085:Graft Survival; D006801:Humans; D017078:Laser-Doppler Flowmetry; D007869:Leg Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008866:Microsurgery; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing