A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft
Identifieur interne : 002E45 ( Main/Exploration ); précédent : 002E44; suivant : 002E46A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft
Auteurs : Hyoseob Lim [Corée du Sud] ; Dae Hee Han [Corée du Sud] ; Il Jae Lee [Corée du Sud] ; Myong Chul Park [Corée du Sud]Source :
- Archives of Plastic Surgery [ 2234-6163 ] ; 2014.
Abstract
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.
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.
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.
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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DOI: 10.5999/aps.2014.41.2.126
PubMed: 24665420
PubMed Central: 3961609
Affiliations:
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Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea><wicri:noRegion>Suwon</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Il Jae" sort="Lee, Il Jae" uniqKey="Lee I" first="Il Jae" last="Lee">Il Jae Lee</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea><wicri:noRegion>Suwon</wicri:noRegion></affiliation></author><author><name sortKey="Park, Myong Chul" sort="Park, Myong Chul" 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uniqKey="Lim H" first="Hyoseob" last="Lim">Hyoseob Lim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Anyang</wicri:regionArea><wicri:noRegion>Anyang</wicri:noRegion></affiliation></author><author><name sortKey="Han, Dae Hee" sort="Han, Dae Hee" uniqKey="Han D" first="Dae Hee" last="Han">Dae Hee Han</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea><wicri:noRegion>Suwon</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Il Jae" sort="Lee, Il Jae" uniqKey="Lee I" first="Il Jae" last="Lee">Il Jae Lee</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea><wicri:noRegion>Suwon</wicri:noRegion></affiliation></author><author><name sortKey="Park, Myong Chul" sort="Park, Myong Chul" uniqKey="Park M" first="Myong Chul" last="Park">Myong Chul Park</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon</wicri:regionArea><wicri:noRegion>Suwon</wicri:noRegion></affiliation></author></analytic><series><title level="j">Archives of Plastic Surgery</title><idno type="ISSN">2234-6163</idno><idno type="eISSN">2234-6171</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Jeng, Sf" uniqKey="Jeng S">SF Jeng</name></author><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nogueira, A" uniqKey="Nogueira A">A Nogueira</name></author><author><name sortKey="Martinez, Mj" uniqKey="Martinez M">MJ Martinez</name></author><author><name sortKey="Arriaga, Mj" uniqKey="Arriaga M">MJ Arriaga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Innis, Co" uniqKey="Innis C">CO Innis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zeligowski, Aa" uniqKey="Zeligowski A">AA Zeligowski</name></author><author><name sortKey="Ziv, I" uniqKey="Ziv I">I 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last="Lee">Il Jae Lee</name><name sortKey="Park, Myong Chul" sort="Park, Myong Chul" uniqKey="Park M" first="Myong Chul" last="Park">Myong Chul Park</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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