Arch Plast Surg.  2014 Mar;41(2):126-132. 10.5999/aps.2014.41.2.126.

A Simple Strategy in Avulsion Flap Injury: Prediction of Flap Viability Using Wood's Lamp Illumination and Resurfacing with a Full-thickness Skin Graft

• Lim H
• Han DH
• Lee IJ
• Park MC

• KMID: 1972035
• DOI: http://doi.org/10.5999/aps.2014.41.2.126

Abstract

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.

Keyword

Tissue survival; Dermis; Skin transplantation; Soft tissue injuries; Extremities

MeSH Terms

Dermis
Extremities
Fluorescein
Free Tissue Flaps
Heel
Humans
Injections, Intravenous
Lighting*
Methods
Necrosis
Skin Transplantation
Skin*
Soft Tissue Injuries
Tissue Donors
Tissue Survival
Transplants*
Fluorescein