Early Dangling Protocol Post Lower Extremity Free Flap Surgery: An Evidence-based Case Report
DOI:
https://doi.org/10.14228/jprjournal.v10i2.346Keywords:
Free Tissue Flaps, Lower extremity, Postoperative period, Early AmbulationAbstract
Background: Free flap is tissue transplantation by including its feeding artery from one body part to another. Intravascular thrombosis is the main obstacle commonly faced in the anastomosed part. Yet, postoperative extremity mobilization has widely become the main question related to flap failure. Only a few studies explained the best time to perform lower extremity mobilization post free flap surgery to maintain adequate flap viability. This study aimed to find the effectiveness of the dangling protocol in reducing lower extremity free flap surgery complications.
Methods: A literature search was conducted through PubMed, Cochrane, and Embase in March 2022 using “Free tissue flap” or “free flap” AND “dangling protocol” or “early ambulation” AND “postoperative complication” keywords. Title and abstract screening, full-text reading, and eligibility assessment were performed to find related evidence regarding our clinical question.
Results: The two relevant articles are a systematic review and a clinical trial study. Both studies showed 94-100% flap viability after applying early dangling protocol as early as three days post lower leg free flap surgery with level evidence of IIB up to IV without any incidence of flap necrosis.
Conclusion: Early dangling protocol can be implemented safely after free flap surgery of the lower extremity without postoperative complications such as total or partial necrosis.
References
Ow TJ, Myers JN. Current management of advanced resectable oral cavity squamous cell carcinoma. Clin Exp Otorhinolaryngol. 2011;4(1):1-10. DOI: https://doi.org/10.3342/ceo.2011.4.1.1
Sittitrai P, Reunmarkkaew D, Chaiyasate S. The role of induction chemotherapy followed by surgery in unresectable stage IVb laryngeal and hypopharyngeal cancers: a case series. J Otolaryngol Head Neck Surg. 2018;47(1):62. DOI: https://doi.org/10.1186/s40463-018-0310-y
Paderno A, Piazza C, Bresciani L, Vella R, Nicolai P. Microvascular head and neck reconstruction after (chemo)radiation: facts and prejudices. Curr Opin Otolaryngol Head Neck Surg. 2016;24(2):83-90. DOI: https://doi.org/10.1097/MOO.0000000000000243
Herle P, Shukla L, Morrison WA, Shayan R. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg. 2015;85(3):121-7. DOI: https://doi.org/10.1111/ans.12888
Arce K, Bell R, Potter J, Buehler MJ, Potter BE, Dierks EJ. Vascularized free tissue transfer for reconstruction of ablative defects in oral and oropharyngeal cancer patients undergoing salvage surgery following concomitant chemoradiation. International journal of oral and maxillofacial surgery. 2012;41:733-8. DOI: https://doi.org/10.1016/j.ijom.2012.03.004
Fujioka M. Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers. ISRN Plastic Surgery. 2013;2013. DOI: https://doi.org/10.5402/2013/952971
De Wilde R, Boeckx W, Van Der Schueren E, Guelinckx P, Gruwez J. A scanning electron microscopic study of microvascular anastomoses on irradiated vessels: Short-term effect of irradiation. Microsurgery. 1983;4(3):193-200. DOI: https://doi.org/10.1002/micr.1920040311
Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A, et al. Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx. 2018;45(6):1135-42. DOI: https://doi.org/10.1016/j.anl.2018.03.008
Sun G, Lu M, Tang E, Yang X, Wen J, Wang Z. Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2011;112(1):34-41. DOI: https://doi.org/10.1016/j.tripleo.2010.09.062
Yamaguchi K, Kimata Y, Onoda S, Mizukawa N, Onoda T. Quantitative analysis of free flap volume changes in head and neck reconstruction. Head Neck. 2012;34(10):1403-7. DOI: https://doi.org/10.1002/hed.21944
Longo B, Pagnoni M, Ferri G, Morello R, Santanelli F. The Mushroom-Shaped Anterolateral Thigh Perforator Flap for Subtotal Tongue Reconstruction. Plastic and Reconstructive Surgery. 2013;132(3):656-65. DOI: https://doi.org/10.1097/PRS.0b013e31829acf84
Leymarie N, Karsenti G, Sarfati B, Rimareix F, Kolb F. Modification of flap design for total mobile tongue reconstruction using a sensitive antero-lateral thigh flap. J Plast Reconstr Aesthet Surg. 2012;65(7):e169-74. DOI: https://doi.org/10.1016/j.bjps.2011.11.012
Engel H, Huang JJ, Lin CY, Lam W, Kao HK, Gazyakan E, et al. A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg. 2010;126(6):1967-77. DOI: https://doi.org/10.1097/PRS.0b013e3181f44742
Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y. Free-Flap Reconstruction of the Tongue. Semin Plast Surg. 2019;33(1):38-45. DOI: https://doi.org/10.1055/s-0039-1677789
Baas M DL, Corten EM, Mureau MA. A systematic review on the sensory reinnervation of free flaps for tongue reconstruction: Does improved sensibility imply functional benefits? J Plast Reconstr Aesthet Surg. 2015;68(8):1025-35. DOI: https://doi.org/10.1016/j.bjps.2015.04.020
Biglioli F, Liviero F, Frigerio A, Rezzonico A, Brusati R. Function of the sensate free forearm flap after partial glossectomy. J Craniomaxillofac Surg. 2006;34(6):332-9. DOI: https://doi.org/10.1016/j.jcms.2006.04.005
Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol. 2015;22(9):3061-9. DOI: https://doi.org/10.1245/s10434-015-4386-6
Ozkan O, Ozkan O, Derin AT, Bektas G, Cinpolat A, Duymaz A, et al. True functional reconstruction of total or subtotal glossectomy defects using a chimeric anterolateral thigh flap with both sensorial and motor innervation. Ann Plast Surg. 2015;74(5):557-64. DOI: https://doi.org/10.1097/SAP.0b013e3182a6add7
Narui K, Ishikawa T, Satake T, Adachi S, Yamada A, Shimada K, et al. Outcomes of immediate perforator flap reconstruction after skin-sparing mastectomy following neoadjuvant chemotherapy. Eur J Surg Oncol. 2015;41(1):94-9. DOI: https://doi.org/10.1016/j.ejso.2014.09.001
Azzawi K, Ismail A, Earl H, Forouhi P, Malata CM. Influence of neoadjuvant chemotherapy on outcomes of immediate breast reconstruction. Plast Reconstr Surg. 2010;126(1):1-11. DOI: https://doi.org/10.1097/PRS.0b013e3181da8699
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Parintosa Atmodiwirjo, Timothy Aditya, Muhammad Tafdhil Tardha, Fadli Nazwan Sani
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain the copyright of the article and grant Jurnal Plastik Rekonstruksi the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License. Articles opting for open access will be immediately available and permanently free for everyone to read, download and share from the time of publication. All open access articles are published under the terms of the Creative Commons Attribution-Non-commercial-NoDerivatives (CC BY-NC-ND) which allows readers to disseminate and reuse the article, as well as share and reuse of the scientific material. It does not permit commercial exploitation or the creation of derivative works without specific permission.
