A simple and effective method to optimize limb position after complex lower limb free flap reconstruction with concurrent external fixation复制标题

一种简单有效优化下肢游离皮瓣并行外固定重建术后肢体位置的方法

In complex lower extremity reconstruction following trauma, immobilization with external fixation may add an ergonomic obstacle to performing a comfortable and efficient-free flap surgery. In addition, positional changes of the limb may compromise the venous circulation of the flap. In this regard, various postoperative measures such as limb positioning, external fixator devices, and regular compression stockings have been described in an attempt to decrease post-operative edema and reduce potential complications. Herein, we share a simple customizable solution that aids immediate postoperative extremity immobilization in the position of optimal flap perfusion. An external scaffold is individually constructed for each patient by the surgeon postoperatively using long solid struts of Zimmer splints reinforced and enclosed within plaster of Paris (POP). The Zimmer splint scaffold is formed in an “H” format and is fully customizable before the POP sets to interact with the external fixation hardware, maintaining the limb in a stable and safe position with the desired elevation. This scaffold is especially useful to safeguard large flaps with a single venous anastomosis, as they might be sensitive to positional changes. From November 2010 to June 2017, we applied this scaffold in 22 patients who underwent complex lower extremity orthoplastic procedures with free flaps and have seen no position-related flap complications nor heel ulcers.

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