Due to the complex, and often tenuous nature of microsurgical tissue transfer, postoperative monitoring of free tissue flaps plays a vital role in the management of such patients. Some of the more challenging reconstructive problems occur in patients with lower extremity trauma, yet to date, no preferred protocol exists for the postoperative care of lower extremity free flaps. The present study sought to evaluate and assess current preferences in monitoring following lower extremity free tissue transfer. Members of the American Society of Plastic Surgeons (ASPS) were surveyed with regard to their choice for postoperative monitoring and return to dependent positioning ("dangling"). The results demonstrate that there is some agreement among surgeons regarding the optimal means for postoperative monitoring. Most rely on clinical observation in addition to conventional Doppler probe for an average of 4.8 days. Most surgeons follow their own flaps in addition to relying on the residents and nursing staff. The study also notes a wide variety in the times and frequencies at which dangling of the extremity was commenced. Most respondents initiate dangling within 2 weeks of surgery and begin with only 1 to 5 minutes per session.

This study evaluated the social and psychologic impact of facial trauma on previously healthy individuals. Inclusion criteria for the study included 18- to 45-year-old individuals who had a facial laceration of 3 cm or greater and/or a fractured facial bone requiring operative intervention within 6 months to 2 years prior to participation in the study. Retrospective analysis of patients at Yale New Haven Hospital Emergency Department was done between May 1997 and December 1998. When compared with a control population, the study group showed a statistically significant lower satisfaction with life, more negative perception of body image, higher incidence of posttraumatic stress disorder, higher incidence of alcoholism, and an increase in depression. Also, among the study group there was a significantly higher incidence of posttrauma unemployment, marital problems, binge drinking, jail, and lower attractiveness scores. In conclusion, in this preliminary study, it appears that the result of facial scarring/trauma includes a significantly decreased satisfaction with life, an altered perception of body image, a higher incidence of posttraumatic stress disorder, a higher incidence of alcoholism, and increased posttrauma jail, unemployment, binge drinking, and marital problems. Thus, it appears that there is significant negative social and functional impact related to facial trauma and scarring.