Psychological and supportive needs during postoperative bed rest following free flap reconstruction of the lower extremity.

Abstract

Postoperative bed rest following lower extremity free flap reconstruction represents a standard of care required to ensure microsurgical success and it also poses substantial physical and psychological challenges to the patient. We investigated patients' subjective experiences, unmet needs, and support preferences during immobilization. A cross-sectional survey was conducted among 93 patients who underwent lower limb free flap surgery. A questionnaire was used to assess pain, emotional symptoms, perceived support, and desired interventions. Descriptive and inferential statistics, including the Chi²-tests and logistic regression, were used to examine associations between clinical symptoms and support preferences. Significant pain during bed rest was reported by 60% of the patients, emotional symptoms by 93%, and 67% expressed a desire for structured daily routines. Improved preoperative planning was requested by 47%, and 25% expressed a wish for more information. However, only 11% of the patients asked for enhanced pain management and 10% for desired psychological support. Perceived insufficiency in preoperative planning was significantly associated with the wish for structured activation (p = 0.001), and logistic regression confirmed that patients reporting insufficient preoperative planning were significantly more likely to prefer structured activation during the immobilization period (OR 6.87, 95% CI 2.10-22.42, p = 0.001). A wish for more clinical information showed a positive but non-significant association with the patients' preference for structured activation (OR 3.67, 95% CI 0.83-16.25, p = 0.087). Although clinical recovery may progress as expected, the psychosocial dimension of immobilization often remains insufficiently addressed. High demand for structured engagement and better planning underscores the need for multimodal inpatient strategies that integrate emotional, cognitive, and organizational support during bed rest.