Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_612_Библиотеки_им_академика_М_И_Перельмана

Even perfectly planned and elevated flaps can develop issues. Venous outflow problems are more common than arterial inflow. Veins are lower pressure systems and more susceptible to kinking or compression. A venously congested skin flap will appear darker than normal and will bleed brisk dark blood upon scratching the epidermis. One of the first actions that can be taken is to release some of the sutures to alleviate pressure. If this is ineffective, it must be decided whether the problem can be fixed by urgently returning to the operating room. Flaps with large named vessels can be reopened and checked for pedicle kinking, and free flaps can be checked for anastomotic issues. If all vessels and anastomoses are patent, the venous drainage of the remaining blood supply may be inadequate. There are a few ways to augment venous drainage. The flap can be venously supercharged by hooking up another vein to drain the flap. Alternatively, the flap can be simply allowed to bleed until inosculation and neovascularization of the flap occur. Deepithelialization and application of heparin-soaked dressings will promote continued bleeding. The use of medicinal leeches or Hirudo