An early and aggressive start of a combined dangling/wrapping procedure does not compromise flap circulation and allows mobilizing patients after free flap transfer to the lower extremity at an early stage. This approach improves patient comfort, shortens the hospital stay, and therefore reduces socioeconomic costs.

Background The ideal starting point for flap training (FT) with the combined wrapping and dangling procedure is still a question of debate. Most units follow their own established protocols and currently evidence of flap compromise due to FT is still lacking. The aim of this study was to prove if an early and "aggressive" wrapping and dangling protocol could lead to metabolic changes, measured by microdialysis, indicating ischemia resulting in compromised flap perfusion. Methods Between 2010 and 2014, 49 patients with microvascular free flap reconstruction of the lower limb were included in this study. Patients were randomized into two groups. Group I started FT on the 7th postoperative day, and group II started on day 3. FT consisted of a combined wrapping and dangling procedure doubling its duration daily and ending at day 5. Flaps were monitored clinically and by microdialysis for ischemia-induced changes and metabolic parameters in the flap tissue in respect to different starting points of FT. Results All 49 patients in both groups were able to complete the postoperative FT without complications. Noninferiority of the early group could be proven and microdialysis results showed no differences between both groups. Conclusion We could prove by microdialysis that an early start of FT does not lead to compromised flap perfusion. Moreover, an early start of FT can lead to a reduced length of hospital stay. Furthermore, a reduced risk for deep vein thrombosis, pulmonary embolism, and pneumonia due to earlier mobilization might be an appreciated side effect.

H. Kosc~IITZ-Koslc, W. I{O/-ILEI~ u. X. NEUBERT : Dokumentationserfahrungen 699 Als wichtig erscheint tier Hinweis, dM] der mit dem Radiologen gemeinsam aufgestellte Therapieplan dokumentarisch festgelegt ~ird und einer KontrollmSglichkeit unterliegt. Bei der Nachuntersuehung soll der Arzt zur schnellen Orientierung mit einem Blick den bisherigen Krankheitsver]auf fibersehen k5nnen. Dazu dient eine Zeitskala, in S~ulenform dargestellt und unterteflt je nach Wiehtigkeit in Mortars-und Jahresabschnitte (vgl. Abb. 4, linker Rand). Von Naehkontrolle zu Nachkontrolle wird die Rezidivfreiheit rot, -verdaeht blau und Rezidiv weiB gekennzeichnet. Abschlief~end Ski noeh auf eine Einlegekarte aufmerksam gemacht, die im Bedarfsfalle zur weiteren Aufnahme der ]aufenden Nachuntersuehungsberichte dient und die somit eine Neuausstellung einer zweiten Faltkarte erspart. Zur Aufnahme yon Briefen und Befundberichten ist dieser eine Kunststoff-Folie aufgeschweif3t. Vorsitzender: Ich danke Herrn Sl~IESSl~ und bitte nun um den Vor~rag Kosc~nTz-Koslc und KOm~l~: Dokumentation8er/ahrungen aus einer Betreuungsstelle /iLr Magenkranke und Magenoperierte. Es spricht Herr KoscI~Imz-Koslc.

Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.

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