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| Effect of early postoperative mobilization on functional recovery, hospital length of stay, and postoperative complications after immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects: a prospective, randomized controlled trial |
| Lima de Araujo CA, de Freitas Busnardo F, Thome Grillo VA, Chirnev Felicio CH, Antonia de Almeida LA, Sparapan Marques CF, Nahas CS, Imperialle AR, Gemperli R, Ribeiro Jr U |
| Annals of Surgical Oncology 2024 Feb;32(2):993-1004 |
| clinical trial |
| This trial has not yet been rated. |
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BACKGROUND: Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5 days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients. METHODS: This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life. RESULTS: On day 5, EM improved ambulation significantly compared with BR (68.0% versus 38.5%; p = 0.035) and achieved greater 6MWT distances on days 5 (108.78 versus 47.73m; p = 0.041) and 30 (243.8 versus 166.29 m; p = 0.018). The EM patients were discharged earlier (66.7% by day 10 versus 33.3% of the BR patients; p = 0.043), with comparable healing times (p = 0.06) and postoperative complication rates (68% versus 80.8%; p = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups. CONCLUSION: Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications.
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