EP-583 Review of lower limb orthoplastic flap monitoring protocol

Abstract

Abstract Aim To improve upon the existing muscle and fascio-cutaneous flap monitoring protocol. The objective is to follow the patient's journey from the time of admission up to discharge and then follow up, in a tertiary care hospital in the Northern region of England, United Kingdom. Method The patients were selected from the online plastic surgery audit tool regularly used for documentation, handover and maintaining continuity of care. We looked at the patients requiring free muscle flaps, pedicled muscle flaps and fascio-cutaneous flaps, following fractures sustained to the lower limb, from April 2016 to April 2021. The exclusion criteria were elective free flaps or pedicled flaps and open fracture with no wound management concerns. The parameters being evaluated were patient observations, flap observations, urine output, bloods, intravenous fluids, patient-controlled analgesia, oxygen, dressing, nutrition, mobility and follow up. Following analysis of the results, a more standardised protocol was distributed across the wards. The response to the new monitoring protocol was measured based on continuity of care, staff satisfaction and outcomes. Results There was an initial need for standardisation of monitoring protocols and elimination of multiple charts. This included the nutrition status, use of blood products, dressings and physiotherapy, in addition to the previously mentioned parameters. Conclusion The staff feedback was positive and felt better equipped. It removed the ambiguity and patients were aware of their follow up dates prior discharge. The collaboration with the physiotherapy team was well coordinated. This led to an organised recovery period.