Journal of Aesthetic & Reconstructive Surgery

Efficacy of Scratch Test in Free Flap Monitoring

Introduction: Re-exploration of the failing free lap at the earliest provides the best chance for successful salvage. We describe our experience with scratch test as an adjunct to clinical monitoring that provides quick and reliable results at near negligible cost to monitor the viability of the free lap in the early post operative period.

Materials and methods: A prospective, observational study was conducted from January 2018 to December 2020 on patients undergoing free laps where skin paddle was available for monitoring. Scratch test was performed by making a 2-3 mm horizontal scratch up to the dermis using a 28 gauge needle on the distal aspect of the lap. Bright red coloured blood (appearing between 3-12 seconds) was considered normal, while dark coloured blood (appearing within 3 seconds) or no blood appearing till 12 seconds were considered suggestive of vascular compromise. The scratch test commenced on the operating table immediately a ter completion of lap inset, and continued till 72 hours post-operatively.

Results: 122 patients were enrolled in the study over the period of 02 years. Scratch test was normal in 111 cases (91%) for initial 72 hours following the surgery. Eleven patients overall (11/122) exhibited features of vascular compromise on scratch test when the clinical examination was either normal or equivocal at that instant. Eight out of these eleven patients (8/11) exhibited features of venous congestion, whereas three patients (3/11) exhibited arterial blockage. All these patients underwent prompt reexploration where the vascular compromise was corrected. Early identi ication helped in complete salvage of six out of eleven compromised laps.

Conclusion: Scratch test has the potential to alert at the earliest for development of vascular compromise preceding the other clinical signs. This may enable re-exploration at the earliest for the higher rates of successful salvage of the failing laps.

Author(s): Sumedha Wadhwa*

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