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Lower Extremity Wound Consult Evaluation:
- Mechanism of wound
- Size of wound
- Prior surgeries
- Existing hardware?
- Current dressing/vac, etc
- Weight bearing status
- Infection? Osteo versus soft tissue only.
- Antibiotics? Follow ALL cultures; know if they are soft tissue versus bone
- Has CTA runoff been obtained?
- Needs to be on SQH 5000U TID and hold the AM dose if going to OR
- Follow up CBCs especially after OR with ortho. If Hct is <28, will transfuse day BEFORE surgery.
- If planning for poss free flap, need to T&C 2u RBC.
- If going to surgery, need to make NPO, IVF, pre-op abx.
Iorio Lower ext path:
Prior to OR: transition to heparin at time of consult, eval for CTA vs angio
Day of OR: Hct 25-27
POD1: Conversation about starting ASA 81, Heparin 5000 SQ TID (usually at night if flap is soft and drain output low). Heparin gtt reserved for special cases.
POD2: Start dangle protocol (unless in frame)
POD3: Out of ICU, Q2hr checks
Note: Muscle flaps do not accommodate dangles (ie venous return) the same way as skin flaps. Dangles usually start on POD#5 or POD#6.
Denver Health:
Wong Lower Extremity Pathway:
- Bedrest with leg elevated for 5 days
- POD5 (or anytime not on the weekend) begin dangle protocol
- Dangle: POD5 5 min TID; POD6 10 min TID; POD7 20 min TID, then home
- No wrapping or compressing of leg during dangle