Abstract
Flap loss due to postoperative flap edema and thrombosis of the anastomosis remains
the predominant concern of reconstructive microsurgeons. Due to the lack of scientific
evidence, there is no unanimous opinion on when to mobilize a reconstructed lower
extremity, reflecting the uncertainty of plastic surgeons regarding the effect of
the dangling procedure on flap microcirculation.
Patients and Methods In this randomized controlled clinical trial, we included 31 patients undergoing
free flap transfer to the lower extremity.
The patients were randomly divided into two groups. Cohort I consisted of 15 patients
starting the dangling procedure at day 7, and cohort II consisted of 16 patients in
which an early aggressive postoperative dependency started at day 3.
Wrapping and dangling of the flap was performed primarily with a duration of 5 minutes
three times a day and increased daily by doubling the duration over a period of 4
days, reaching 60 minutes at day 5.
Before and immediately after each dangling procedure the flaps were clinically monitored
under direct observation for color, capillary refill, venous congestion, flap turgor,
and flap temperature.
Results In all cases the postoperative course was uneventful, resulting in a success rate
of 100%. No adverse effects or flap compromise were seen due to the combined dangling/wrapping
procedure.
Conclusion An early and aggressive start of a combined dangling/wrapping procedure does not
compromise flap circulation and allows mobilizing patients after free flap transfer
to the lower extremity at an early stage. This approach improves patient comfort,
shortens the hospital stay, and therefore reduces socioeconomic costs.
Keywords
dangling - microcirculation - lower extremity - free flap - prospective study - randomized
