# Total Contact Cast after Sole Free Flap Reconstruction for Early Ambulation

## TL;DR

This study explores using total contact casts after foot surgery to help patients with severe leg ischemia walk earlier and recover faster.

## Contribution

The study introduces the use of total contact casts post-free flap surgery to enable early weight-bearing in CLTI patients.

## Key findings

- TCC group had earlier weight-bearing initiation compared to the non-TCC group, though not statistically significant.
- Wound dehiscence and ulcer rates were lower in the TCC group, but differences were not statistically significant.
- Flap size was smaller in the TCC group, but the difference was not statistically significant.

## Abstract

Background
 Free flap reconstruction can be performed in patients with chronic limb-threatening ischemia (CLTI). However, early walking training may increase the risk of wound dehiscence and prolong hospitalization. Total contact cast (TCC) treatment effectively addresses diabetic plantar ulcers by immobilizing the foot and distributing weight away from the ulcer area. This study aimed to assess the effect of postoperative TCC use on early limb loading and hospital stay in patients with CLTI with free flaps.

Methods
 Patients with CLTI who underwent free flap reconstruction between 2006 and 2023 were enrolled in this study. Postoperative time until weight-bearing initiation was compared between the TCC (
n
 = 5) and non-TCC groups (
n
 = 7).

Results
 The time to the initiation of weight-bearing on the affected limb was 52.3 ± 33.2 days in the non-TCC group and 19.8 ± 3.56 days in the TCC group (
p
 = 0.105). The wound dissection rates were 42.9% (3/7) in the non-TCC group and 20% (1/5) in the TCC group (
p
 = 0.408). At discharge, 28.6% (2/7) of the non-TCC group and 20% (1/5) of the TCC group had ulcers (
p
 = 0.735). The average flap size was 149 ± 69.1 cm
2
in the non-TCC group and 95.6 ± 73.1 cm
2
in the TCC group (
p
 = 0.268).

Conclusion
 Postoperative TCC use after free flap foot reconstruction may lead to early weight-bearing of the affected limb. Further studies with larger numbers of cases are needed.