Abstract
Background
Defects of the lower extremity often require free tissue transfer to provide adequate
soft tissue reconstruction. Patients typically undergo a postoperative dangle protocol
to condition the flap to withstand the increase in venous pressure. The purpose of
this study was to evaluate the safety and postoperative length of stay after early
initiation of dangle.
Methods
A retrospective review of patients undergoing lower extremity free tissue transfer
reconstruction at the Grady Memorial Hospital from 2012 to 2022 was conducted. Patient
demographics, surgical characteristics, and outcomes were analyzed. Patients were
categorized into two groups: early (within 5 days after surgery) and late dangle (day
6 or greater). Univariate and multivariate statistical analyses were performed, with
significance determined to be p < 0.05.
Results
A total of 83 of 99 available patients met inclusion criteria; 22 patients underwent
early and 61 late dangle. Free flap survival was 90.9% in the early and 90.2% in the
late group. The mean postoperative length of stay in the early and late groups were
12.3 and 18.8 days, respectively (p = 0.0018). There was no difference in the number of patients who had wound healing
complications, flap failure, and a need for amputation in each group.
Conclusion
Our results demonstrate that initiation of an early dangle protocol does not affect
surgical outcome and leads to a reduction in postoperative length of stay. These results
can be used to inform evidence-based recommendations for flap management in lower
extremity reconstruction.
Keywords
dangle protocol - free flap - outcomes
