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Information for Patients
In less than 5% of patients, perfusion or drainage of blood going to the flap can become compromised. This can be the consequence of either thrombosis of a vessel going to the flap or possibly kinking of a vessel that restricts the flow. If this situation is recognized quickly and expeditiously corrected the flap will go on to survive and all will heal in a normal manner. If the vascular compromise is not recognized or is allowed to continue, there will be resultant damage and possible loss of the entire flap.
Taking care in doing the procedure, making sure that the joining of the blood vessels is perfect, trying to avoid diseased segments of blood vessels, following the course of the blood vessels to make sure there is no kinking or twisting all decrease the likelihood of flap compromise. Even with this care, situations do arise where the flap can become compromised. It is for this reason that all flaps are monitored clinically for the entire hospital stay and with the tissue oximeter during the critical first 36 hours. All monitoring is done in a non-invasive way. Patients will spend the first night in the recovery room where the nursing intensity allows for more frequent observations. Monitoring then continues on the nursing floor. I only utilize one particular area of the hospital where the nurses have been taught flap observation.
The tissue oximeter by ViOptix™ is a device that I developed a research interest in over three years ago. The probe sits on the surface of the skin and with light measures the oxygen content in the tissue underneath. There is a continuous measurement made of the tissue perfusion along with the appropriate alarms. While I use the ViOptix™ T. Ox. on all patients, it is particularly helpful in very light and darker skinned individuals, and individuals with black and blue areas in whom subtle changes in skin color are difficult to detect.
I believe it is unnecessary to monitor the viability of a flap once a patient has been discharged from the hospital. I have never had a patient return with a compromised flap after they have been discharged.