O68: REDUCING VENOUS CONGESTION FOLLOWING LOWER LIMB RECONSTRUCTION WITH ISOMETRIC CALF EXERCISES: A PROSPECTIVE CLINICAL STUDY. (27th April 2021)

• Record Type: Journal Article
• Authors: Geoghegan, L; Kwasnicki, RM; Henton, JM; Hettiaratchy, S; Jain, A
• Is Part Of: British journal of surgery. Volume 108(2021)Supplement 1
• Publication Date: 2021-04-27
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab117.068
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Early post-operative dependency aids healing following lower limb reconstruction although increases venostasis and reduces perfusion in the acute setting. The commonest cause of lower limb flap failure is venous congestion and external compression with stockings and pneumatic devices is contraindicated. The aim of this clinical study was to determine whether venous congestion could be reduced through patient-led isometric contractions following lower limb reconstruction. Method: A single centre prospective clinical study was conducted at St. Marys Hospital, Imperial College NHS Trust. Combined tissue photospectroscopy and laser Doppler (O2C, LEA, Germany) was used to assess superficial oxygen saturation, venous congestion and flow during standardised training regimens. Haemodynamic parameters were collected in an acute post-operative and outpatient rehabilitation cohort. Result: In the acute post-operative cohort, isometric contractions failed to improve superficial flow following dependency on the post-operative day (POD) one (-44% ± 8). Isometric contractions improved superficial flow from POD5 (+11% ± 102) although venous congestion remained higher than measurements taken during rest (+32% ± 54). In the outpatient rehabilitation cohort isometric contractions significantly increased superficial flow following dependency (+16% ± 33, p=0.01) at a mean of 14 weeks since discharge. Conclusion: This study provides objective physiological evidence of the haemodynamic changes that occur with dependency and isometric contraction following lower limb reconstruction. These physiological changes evolve following extremity reconstruction and it appears that a continued healing effect exists to accommodate progressive changes in flow dynamics. The present findings could be used to inform enhanced recovery programmes following limb reconstruction. Take-home message: Simple patient-led calf contractions reduce venous congestion and improve cutaneous flow following lower extremity reconstruction.