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 VFTFs are pale after transplantation (pictured
left a venous flap used to resurface a thumb tip amputation). This
usually lasts for several hours. Viability and flow through the system can be
monitored by palpation of its pulse or Doppler evaluation. After several hours
the flap regains capillary refill. This pattern of delay prior to capillary
refill is related to opening of the arterial-venous shunts triggered by ischemia
in the overlying skin.
Over the next days to weeks the flap will appear
congested and ecchymotic. Evaluation by capillary refill is obscured. Palpation
of the pulse or Doppler evaluation is used to confirm viability.
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A venous flap used to resurface the thumb becomes
congested with evidence of epidermal necrosis after 3 days. The flap
however, is still viable and will completely survive. |
After about 2 weeks congestion resolves and
superficial epidermalysis is removed uncovering pink healthy tissue.
The VFTF does not replace conventional flaps, which
utilize local tissue. It offers an excellent option when adequate adjacent
tissue sources like cross-finger flaps are not available. Other
indications include:
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Injury to multiple digits
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Ulnar hand injuries
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Radial hand injuries
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Defects greater in size than the cross-finger flap
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Thumb injuries
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Patient will not accept additional scars on
adjacent digits
Diffuse injuries to the hand can limit the use of
pedicled flaps. Reduced mobility secondary to joint injuries or swelling can
make thenar and hypothenar flaps technically impossible. A pedicled groin flap
can cause unnecessary swelling secondary to dependency, and unnecessary
disability secondary to prolonged time to rehabilitation.
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