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KMID : 1038220140410020126
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Archives of Plastic Surgery
2014 Volume.41 No. 2 p.126 ~ p.132
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A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood’s Lamp Illumination and Resurfacing with a Full-thickness Skin Graft
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Lim Hyo-Seob
Han Dae-Hee
Lee Il-Jae
Park Myong-Chul
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Abstract
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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.
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KEYWORD
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Tissue survival, Dermis, Skin transplantation, Soft tissue injuries, Extremities
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