Ischemia is a major factor contributing to failure of skin flap surgery, which is routinely used for coverage of wounds to prevent infection and to restore form and function.
Any study comparing the use of Cook-Swartz implantable Doppler with clinical assessment in detecting the failure of free flaps will be included.
Our patient declined an amniotic membrane patch graft after a discussion of the possible failure of a conjunctival flap in an eye with compromised vasculature.
Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition.
In the exemplar cases, we can clearly see ischaemia on-set following both arterial occlusion and failure of venous drainage, the two most common causes of flap failure.
However, the most common cause of flap failure is venous thrombus originated from a superficial vein system [17]; moreover, cephalic vein occlusion due to previous intravenous cannulation causes failure of RFFF despite apparent normalcy during flap harvesting [26].
These results show the importance of CTAs as a pre-operative study for the identification of risk factors for venous compromise, and their use should prompt a robust discussion of the risk of flap failure with patients, and contingency planning to augment venous drainage with the superficial system if required.
Imaging may also be of use in the confirmation of flap failure (necrosis) (Fig. 7).
Early compromise, which entails the large majority of flap failure, is often asymptomatic.
However, there is a risk of flap failure, due to thrombosis in the flap pedicle, leading to tissue ischaemia.
The ability to detect partial occlusions would be a useful tool for early prevention of flap failure.
