14 DAYS

Begin the dangling protocol in uncomplicated cases. It may be necessary to delay this step in the presence of external fixators, infection, or delayed wound healing.

All dressings are removed. Inspect the flap and place a 4 x 8 inch piece of gauze over the flap. Wrap Ace bandage from toes to knee at angles in a figure-of-eight pattern to prevent occlusion. Use gentle pressure. There should be greater pressure at the distal end of the foot than proximally. The affected lower extremity is lowered over the side of the bed for 3 minutes initially. Twice daily, dangling is repeated increasing by 30 seconds each session. Flap or donor site should return to a pink color within approximately 5 minutes. If excessive throbbing persists for more than 5 minutes, decrease next session by 30 seconds.

Prolonged discoloration, increasing edema, or signs of vascular compromise should be evaluated immediately by a physician.

Dangling should proceed up to 15 minutes as tolerated. The leg is elevated at all times except when dangling.

3 TO 4 WEEKS

Begin scar massage. Begin active range-of-motion, progressing to strengthening exercises. While the patient is exercising, the lower extremity should not be in the dependent position.

4 WEEKS

Once the patient has progressed to 15 minutes of dangling (at approximately 2 weeks), nonweight-bearing crutch ambulation is initiated. The leg is wrapped in an Ace bandage in the same manner as when dangling.

Begin ambulation for 15 minutes 3 times a day and increase to 30 minutes 3 times a day over a 1-week period.

5 WEEKS

Begin touch-down, weight-bearing ambulation with crutches. Proceed as tolerated to full weight-bearing ambulation, increasing time as tolerated.

6 WEEKS

Measure and fit for Jobst compression stocking at 30 mm Hg pressure. Discontinue use of protective splint.

3 MONTHS

May begin active sports and strenuous exercise as cleared by physician.

6 WEEKS

Measure and fit for Jobst compression stocking at 30 mm Hg pressure. Discontinue use of protective splint.

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