Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

Free flaps are often transferred to the lower extremities after major trauma or extensive resection for tumors.1,2 To ensure the survival of these flaps, prolonged bed rest and elevation have traditionally been considered necessary.3,4 However, prolonged bed rest has several harmful effects, such as delirium, venous thromboembolism, pneumonia, prolonged hospital stays, and increased healthcare costs. Because of these harmful effects, early postoperative mobilization has been advocated in several fields of surgery.5 We wondered whether early mobilization is possible after free-flap transfer to the lower extremities. With standard methods of anastomosis, such as end-to-end and end-to-side anastomoses, the circulation of lower-extremity free flaps is unstable in the acute phase and is greatly affected by limb position.6 To enable early mobilization, the standard methods of anastomosis might need to be abandoned in favor of a new approach, such as flow-through anastomosis, that can stabilize the circulation of flaps in the acute phase.7 Therefore, in this study, we attempted to mobilize patients early after free-flap transfer, with flow-through anastomosis for both arteries and veins, to the lower extremity to repair oncologic defects.