|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| If the nail bed has been exposed, or if a wound edge or exposed tissue surface is accessible, abrasion should cause bright red bleeding. If no bleeding is noted, arterial occlusion is implied. If brisk, dark bleeding occurs, venous insufficiency should be considered. Stabbing with a needle or scalpel yields similar information, but if done repeatedly may cause significant tissue trauma. Turgor in well-perfused replanted digits should approximate the turgor of normal digits. Flaccidity indicates arterial occlusion, while swelling suggests venous obstruction. A well-perfused muscle flap should bulge slightly from its bed, whereas an ischemic flap becomes progressively flattened and soft. Muscle flaps suffering from venous obstruction become tensely swollen.
Well-perfused transplanted muscle twitches with electrical or mechanical stimulation, and observation of muscular response to stimulation can be a measure of viability.1 With ischemia, the muscle's responsiveness diminishes and eventually ceases. Monitoring of free muscle transfer by continuous intermittent evoked potential recording has been described experimentally.2
Physical assessments require a visible surface. When free tissue transfers are buried beneath skin flaps or other cover, exposure of a small portion of the transfer or incorporation of an attached skin island can be the basis for postoperative monitoring.3
Direct Pedicle or Axial Vessel Monitoring
These techniques evaluate the patency of pedicle or axial vessels upon which the survival of the replanted or transferred tissue depends.
TABLE 37-1. Techniques of Circulation and Tissue Monitoring
Arteriography can demonstrate the patency of vascular anastomoses, but is limited as a postoperative monitoring technique because it cannot be done frequently enough to be a practical routine. Vasodilator and thrombolytic therapy can be administered through catheters strategically placed at the time of arteriography.4
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