Comparison of outcomes between early and delayed weight bearing following lower limb free flaps: an 18-month single-center study

Aim: Post-operative protocols following lower limb free flap surgery are not well defined, with a lack of consensus in the literature around limb dependency and weight bearing. The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling (day 3 vs. day 4) and weight bearing (day 5 vs. day 14) post lower limb free flap surgery. Methods: All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database. Patient data were collected from the comprehensive lower limb free flap database, medical notes, and electronic records. Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded. Results: A total of 37 patients, 15 pre- and 22 post-enhanced protocol, were identified for comparison. The mean age was 43 (17-72) with a M:F of 3:1. There was no difference in the type of flap reconstruction between groups, with the anterolateral thigh flap being the most common in both groups. No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol, with the mean length of stay reduced from 12.1 to 10.6 days (P = 0.34). Conclusion: The new enhanced protocol remains the standard of care in our unit, as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.