In briefMonitoring for Upper-Extremity Free Flaps and Replantations
Section snippets
Clinical evaluation
Clinical evaluation includes assessing capillary refill, flap color, and bleeding patterns. This method is best for monitoring cutaneous flaps and is less reliable in the monitoring of muscle flaps with skin grafts.4 Arterial compromise presents with a pale or mottled skin paddle; capillary refill may be longer than 2 seconds.6 In a muscle flap, devoid of a skin paddle, the muscle will look dark, with poor turgor, and fail to contract upon stimulation. In a multicenter prospective study,
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2011, Journal of Hand SurgeryCitation Excerpt :When digital revascularization or replantation fails, it most often occurs between 24 and 72 hours postoperatively. Failure of the salvaged digit is unusual 4 days or more after anastomosis.30 We presume that the protective effect of BTX-B in this study was through vasodilation and blunting of the sympathetic response to the cold and chemical vasoconstrictive stressing.
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2011, Journal of Hand SurgeryCitation Excerpt :This implies that the microsurgical technique is the most critical factor for survival.53 Temperature probes are applied to all replanted digits; however, clinical assessment remains the reference standard for monitoring.54 Available monitoring systems are cumbersome or require special equipment that makes it impracticable for universal implementation.55
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