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The flap often is designed longer and wider than is predicted to be needed. The Crane principle is a concept related to prefabrication. Delaying the flap also can improve the length that may be efficiently transferred. On this course of, increase the flap in 2 levels as an alternative of 1, allowing roughly 7-14 d between the 2 procedures. Dissect or divide the flap partially, leaving some blood supply intact, and leave it in its native mattress. Theories explaining the delay phenomenon embrace vasodilation caused by the sympathectomy and a hyperadrenergic state lasting 18-36 h after a flap is raised. However, this interval of vasoconstriction doesn't occur on the second stage. After profitable flap design and implementation, monitor the flap for viability as early recognition of ischemia is vital in stopping subsequent flap necrosis, thus flap failure. Clinical remark is the perfect method to assess a flap. An extremely pale flap may signify arterial insufficiency, while a blue flap could also be secondary to a failure of venous outflow. Two further checks usually used to assess viability are capillary refill and warmth.
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