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Clinical
monitoring is effective, but can be
difficult, even with the most
experienced observer. Often it can
be tricky to tell if a flap has a
circulatory problem.
The examiner looks at flap color
and sometimes capillary refill or
temperature depending on the setting.
Flap
circulatory disturbances can be divided
into arterial insufficiency and venous
insufficiency. If there is an
arterial circulatory problem the flap
would usually look pale and lack
capillary refill.
Muscle flaps can be particularly
difficult to judge – color change with
loss of a beefy red appearance is most
common.
If venous clot is the cause of
flap failure, the flap generally becomes
congested and bluish in color.
Capillary refill is brisk.
Sometimes poking a flap with an
18 gauge needle (away from the pedicle
site) can help you judge flap
circulation.
If there is no bleeding, the
problem is inflow.
If there is rapid exit of dark
red blood, venous congestion is likely
the problem.
More
sophisticated devices to monitor flap
flow have been developed. The
ideal monitor is reliable, accurate,
simple to operative, continuous and
inexpensive. Several different
monitoring devices are in use now, and
include:
-
Surface
or pencil Doppler
-
Temperature
probe
-
Laser
Doppler probe
-
Quantitative
fluorimetry
-
Implantable
Doppler probe
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