Elsevier

The Journal of Hand Surgery

Volume 33, Issue 10, December 2008, Pages 1905-1908
The Journal of Hand Surgery

In brief
Monitoring for Upper-Extremity Free Flaps and Replantations

https://doi.org/10.1016/j.jhsa.2008.09.011Get rights and content

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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      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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