834 Early Ambulation Initiative Following LE Grafts in Comparison to Our Center’s Traditional Standard of Care: A Retrospective Data Review

Abstract Introduction Our ambulation guideline following LE grafting is loosely defined as bedrest vs. lateral transfers only until POD#5. Patient’s mobility status is increased POD#5 with WB per physician discretion. A proposal was created to initiate mobility earlier than POD#5 for patients with LE grafts. Two of our three surgeons were in agreement with the early ambulation protocol. The third surgeon wished to follow the traditional ambulation practice guideline. This request was respected and made known to all staff for carryover. This afforded us the opportunity of a comparison group with our center’s traditional standard of care functioning as the control group. Methods The proposed early ambulation protocol was influenced by evidence-based practice guidelines as well as surgeon input. Criteria was based upon the location of grafting, graft crossing a joint, size of wound being grafted (< or = 400 cm), and general medical status of the patient. Our early ambulation protocol was established as follows: POD#1 Lateral transfers with involved LE elevated. POD#2 Dependent LE at edge of bed, WBAT short distance ambulation to chair or bathroom with AD. POD#3–4 Increase ambulation as tolerated, assess need for continued splinting, appropriateness of progressive ambulation, AROM exercises. POD# 4–5 Progress ambulation with AD as needed, stairs as needed for discharge, home exercise program. Our inclusion criteria consisted of patients of any age, LE burns with STSG not involving joints/involving joints with appropriate immobilization. Exclusion criteria consisted of fractures of involved LE, patients who were non-ambulatory at baseline, wounds >400 cm2, STSG to plantar aspect of foot, medically unstable patients, and surgeon discretion. Results Data reviewed over an eight month period of time yielded 27 patients who met our established criteria; 26 had no graft loss on the first dressing change. The patient with graft loss was attributed to graft placement directly over bone of the distal phalanx. Comparatively, no loss was noted in the control group with 10/10 patients ambulating on POD#5. Of note, early ambulation was granted for several patients with larger surface areas with no graft loss demonstrated, but were not included in this study. Conclusions In conclusion, 96% of patients demonstrated no graft loss with first dressing change following our early ambulation guideline. All patients who followed the traditional ambulation guideline demonstrated no g