Abstract
Background The 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.
Methods A 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.
Results All 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.
Conclusion Full 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.
Keywords
free flap - dangling - flap training
