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Free Flap Monitoring Guideline

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Canniesburn Unit Free Flap Monitoring Protocol

Free Flap Monitoring frequency

Zero hrs commences at end of operation.

Appropriate monitoring measures should commence in theatre/recovery

Post op. time point Monitoring interval
0-24 hrs 30mins
24 - 48hrs   60 mins
48 - 72hrs 120 mins
72hrs – discharge 480mins

(If patient discharged <72hrs, monitoring no longer required).

Canniesburn Unit Lower limb free flap mobilisation protocol
Day 0/Day of surgery

Bair hugger over limb
For leg positioning please refer to post-op instructions
NBM (sips of water) until early morning Post-Op Day 1 review
ST and SHO review at 2200hrs and consultant update
LMWH at 2200hrs after review
Flowtron/TED on contralateral leg
Urine output 0.5ml-1ml/kg/hr (adjust fluids accordingly).

Day 1

Bair hugger over limb
Complete bed rest. Not to mobilise to toilet.
Patient not to leave ward for tests etc.
For leg positioning please refer to post-op instructions
Eat and Drink after morning WR
Blood tests: Hb, U&E, CRP- Transfuse if Hb<70 or <90 and symptomatic
Urine output 0.5ml-1ml/kg/hr, stop fluids if adequate

Day 2

Bair hugger over limb
Complete bed rest. Not to mobilise to toilet.
Patient not to leave ward for tests etc.
Blood Tests; none unless indicated
Urine output 0.5ml-1ml/kg/hr, stop fluids if adequate

Day 3

Bair hugger over limb
Complete bed rest. Not to mobilise to toilet.
Patient not to leave ward for tests etc.
Bloods tests: none unless indicated.

Day 4

Bair hugger off.
Sit out in chair with leg elevated. Not to mobilise to toilet.
Patient not to leave ward for tests etc.
Blood tests: CRP, WCC.

Day 5

Remove dressings and graft check.
Replace splint if required per consultant instructions.
Patient not to leave ward for tests etc.
Mobilise with physios as per dangle protocol below.
Supervised mobilisation to toilet.
Blood tests: CRP (ensure downward trend)
Start Dangle protocol.

Dangle protocol:
5min leg dependant, then 30min rest and elevation.
2 sets in the morning, 2 in the pm with flap observations after each dangle period

Day 6

Patient not to leave ward for tests etc
Continue physio mobilisation as per dangle protocol below.
Blood tests: none unless indicated.

Dangle protocol:
10min leg dependant, then 30min rest and elevation,
3 sets in the morning, 3 in the pm with flap observations after each dangle period

Day 7

Continue mobilisation with physio.
Can leave ward for X-ray (if required sooner must be discussed with Consultant) Discharge if appropriate.

Editorial Information

Last reviewed: 29 July 2022

Next review: 31 July 2025

Author(s): Mr John Scott – Lead plastic surgeon for clinical governance

Version: 1

Approved By: Mr David McGill – Consultant in plastic surgery