A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft.
10.5999/aps.2014.41.2.126
- Author:
Hyoseob LIM
1
;
Dae Hee HAN
;
Il Jae LEE
;
Myong Chul PARK
Author Information
1. Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
- Publication Type:Original Article
- Keywords:
Tissue survival;
Dermis;
Skin transplantation;
Soft tissue injuries;
Extremities
- MeSH:
Dermis;
Extremities;
Fluorescein;
Free Tissue Flaps;
Heel;
Humans;
Injections, Intravenous;
Lighting*;
Methods;
Necrosis;
Skin Transplantation;
Skin*;
Soft Tissue Injuries;
Tissue Donors;
Tissue Survival;
Transplants*
- From:Archives of Plastic Surgery
2014;41(2):126-132
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Extensive degloving injuries of the extremities usually result in necrosis of the flap, necessitating comprehensive skin grafting. Provided there is a sufficient tool to evaluate flap viability, full-thickness skin can be used from a nonviable avulsed flap. We used a Wood's lamp to determine the viability of avulsed flaps in the operation field after intravenous injection of fluorescein dye. METHODS: We experienced 13 cases during 16 months. Fifteen minutes after the intravenous injection of fluorescein dye, the avulsed skin flaps were examined and non-fluorescent areas were marked under Wood's lamp illumination. The marked area was defatted for full-thickness skin grafting. The fluorescent areas were sutured directly without tension. The non-fluorescent areas were covered by defatted skin. Several days later, there was soft tissue necrosis within the flap area. We measured necrotic area and revised the flap. RESULTS: Among all the cases, necrotic area was 21.3% of the total avulsed area. However, if we exclude three cases, one of a carelessly managed patient and two cases of the flaps were inappropriately applied, good results were obtained, with a necrotic area of only 8.4%. Eight patients needed split-thickness skin grafts, and heel pad reconstruction was performed with free flap. CONCLUSIONS: A full-thickness skin graft from an avulsed flap is a good method for addressing aesthetic concerns without producing donor site morbidity. Fluorescein dye is a useful, simple, and cost-effective tool for evaluating flap viability. Avulsed flap injuries can be managed well with Wood's lamp illumination and a full-thickness skin graft.
