Physical and Psychological Burden of Bed Rest on Patients Following Free Flap Reconstruction of the Lower Limb: A Systematic Review and Possible Solutions.

Background: Postoperative bed rest is considered essential after free flap reconstruction of the lower limb to ensure microsurgical success, but prolonged inactivity can lead to physical deconditioning and psychosocial challenges, even in otherwise healthy patients. While early mobilization protocols improve physical recovery, their impact on psychological wellbeing remains underexplored. This review evaluates the current literature on postoperative protocols in microvascular lower extremity reconstruction, focusing on both physical and mental health outcomes, and explores potential strategies for optimizing recovery. Methods: A systematic review was conducted following the PRISMA guidelines to search PubMed, Cochrane Library, and Embase databases. Studies were included if they explicitly described postoperative immobilization or mobilization protocols and their impact on recovery outcomes, including complications and psychological effects. Results: Sixteen studies met the inclusion criteria, highlighting the potential of early mobilization protocols in reducing complications such as pneumonia, deep vein thrombosis, and prolonged hospital stays. Structured mobilization strategies, such as early dangling and perfusion-controlled mobilization, demonstrated improved microcirculatory adaptation and enhanced recovery outcomes. However, limited to no research addressed psychological resilience and the impact of immobility on patient mental health. Conclusions: Early mobilization protocols significantly improve physical outcomes after free flap surgery, but the psychological and mental effects of postoperative bed rest remain insufficiently studied. Adapting strategies from space medicine, including structured routines, cognitive training, and social engagement, offers promising avenues for enhancing recovery. Future research should focus on integrating physical and psychological interventions into comprehensive, evidence-based recovery protocols to optimize patient outcomes.