A simple method for predicting survival of pedicled skin flaps before completely raising them

Pedicled skin and fasciocutaneous flaps are commonly used in plastic surgery. Once such a flap is completely raised on its pedicle it becomes defenceless against any possible necrosis.

To use a simple method for raising such a flap in a manner that can predict the vascularity better, offering additional protection against necrosis.

A total of 30 skin and fasciocutaneous flaps were raised in 27 patients. They were raised as bipedicle flaps; and the vascularity of the flap was tested by occluding the additional pedicle with a pedicle occlusion clamp. If the vascularity was found to be satisfactory the flap was primarily transferred; if found unsatisfactory it was either delayed or abandoned. The delayed flaps were again tested during transfer.

Nineteen (63.3%) flaps were primarily transferred, 11 (36.7%) flaps were delayed, and two (6.7%) delayed flaps displayed an unsatisfactory pattern during transfer. Twenty-two (73.3%) flaps fully survived and seven (23.3%) underwent partial thickness necrosis at the tip, which healed without any further surgical intervention, making 29 (96.7%) flaps clinically successful. There was major necrosis of one flap. All the flaps with a scar at the base survived.

The clinical success of 96.7% indicated a high-degree of predictability of flap survival through this method. Also, this method could safely assess the vascularity of flaps during primary transfer, during delayed transfer, and also those with a scar at the base.

This technique is recommended in all major pedicled skin and fasciocutaneous flaps.