6201 Standardization of a Post Operative Flap Protocol

Annielyn Azor-Ocampo, BSN, RN, CWOCN, DAPWCA, Madonna Rehabilitation Hospital, Wound & Ostomy Specialty Nurse/ Wound Program Leader, Lincoln, NE
Introduction: Musculocutaneous or fasciocutaneous flaps have become the first choice in the surgical repair of pressure ulcers. Major concern with flap procedure is high incidence in recurrence and complication. Studies have been conducted to determine which surgical technique decreases these complications. According to Thieseen, Filip et.al 1, type of flap used was not associated with post-operative morbidity or recurrence of pressure ulcers.  However little evidence was found that described the components of post-operative flap management and outcomes.

Purpose: Purpose of this literature review was to identify the evidence-based components for post-operative flap management protocol and determine the impact that a standardized flap protocol has on patient outcomes, length of stay (LOS) and rate of complications.  

Method: Extensive literature review was conducted to determine the impact that duration of bed rest and post-operative protocols have on patient outcomes.

Findings: Postoperative management varied widely in the articles reviewed.  Out of the 45 articles relevant to the search, 7 mentioned bed rest and protocols after surgery (fig.1). All protocols were incidental to the study. Only one study mentioned 6 week protocol, Singh, R. et.al.2  The presenting author generated one-year review of the wound program’s goals and outcomes of a Mid-west rehabilitation hospital. Seven out of 10 patients with flap discharged to home setting, 3 patients discharged to their previous skilled nursing facilities. One out of ten patients went to acute care for repair of flap, re-admitted back and discharged to home. This facility uses 6 week bed rest protocol (fig.2).

Summary: Findings indicate that 100% of those discharged with fully healed flaps, average LOS was 48 days meeting the hospital’s program goals. Limitations to this literature review include absence of research on the effects of standardized protocols on patient outcomes following flap surgery. It is recommended that further research be conducted specific to length of bed rest and activity progression to provide evidence for the development of a standardized national protocol.