Haemodynamic changes in lower limb free tissue transfer
Research type
Research Study
Full title
Investigating Lower Limb Tissue Perfusion Changes with Calf Exercises after Reconstructive Surgery: A Feasibility Study
IRAS ID
220689
Contact name
Abhilash Jain
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
High energy traumatic injuries to the lower leg often result in open tibial fractures. This is due to the relatively thin and poorly vascularised skin over the lower leg, meaning direct wound closure is often impossible. With the advent of free flap reconstruction there has been a trend towards limb salvage rather than amputation where possible. The London Orthoplastic Network reports approximately 150 lower limb trauma cases requiring free flap reconstruction present each year to London trauma units. In terms of direct benefits to patients, there is evidence to suggest that limb salvage has statistically better functional outcomes, aesthetic results and overall quality of life in contrast to limb amputation in select cases.
The failure rate for lower limb free flaps is higher compared to free flaps in any other anatomic location, necessitating sound, evidenced-based peri-operative management. Post-operative management protocols for lower limb free flap reconstructions have been developed, however, evidence for their use is lacking. Post-operative management remains largely based on individual preference, with limited evidence to support the use of further adjuncts, such as calf contraction exercises.
Venous insufficiency is the most common cause of re-exploration in free flap reconstruction. Calf compression exercises have been previously validated in reducing venous pooling in other clinical settings, and it seems logical that this would be of benefit in flap training. However, the efficacy of this simple patient-led adjunct to flap training is yet to be established in free-flap patients.
A greater understanding of micro-circulatory changes associated with the early stages of flap training regimens and novel adjuncts will provide a greater evidence base for their use. It is hoped that this will allow clinicians to further optimise post-operative recovery through tailored flap training regimens based upon patient specific physiological factors in order to optimise tissue perfusion.
REC name
London - Bromley Research Ethics Committee
REC reference
17/LO/0433
Date of REC Opinion
2 Mar 2017
REC opinion
Favourable Opinion