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Table of Contents
Nightfloat
Your biggest job will be to check on the flaps overnight and make sure they are doing okay. If there is a problem, the ON CALL plastics resident will want to know as quickly as possible. A “heads up” text that you are going to see a flap in trouble is always a good move. If something is wrong, you must make contact with the ON CALL resident. Call or page.
When evaluating a flap, here are the things to look for:
Arterial: There will be a doppler box in the room and you need to look for the marked stitch.
Venous: There is a box in the room called the venous coupler. Please make sure it sounds like a sea shell up to your ear and that it modulates when the patient takes a breath.
Oxygenation: If there isn't a venous coupler, the patient should have a machine called vioptix. This is basically a pulse-ox. Report the oxygenation percentage and the signal strength. Flaps are in trouble if there is a sudden drop.
Color: Is the flap pink, pale or blue?
Capillary refill: How long does it take for the flap refill with blood? Normal is 2 seconds. Brisk means venous congestion. Sluggish means arterial compromise.
Temperature: Is the flap warm or cold?
Turgor: Is the flap soft or hard like a rock?
Drains: What are the drains putting out?