BACKGROUND
Although many systems are available, there is no consensus as to which is the most effective method to monitor cutaneous flaps.1 Most clinicians rely on clinical examination: colour, capillary refill time, temperature and bleeding in response to scratch are among the most common indicators. In many cases, it can be difficult to assess colour and refill. Interobserver variation, degree of digital pressure and lighting are variables that may contribute to the difficulty in determining these signs. A Campbell de Morgan spot is a sharply circumscribed vascular proliferation that usually appears spontaneously after the age of 40 years. Histologically, they consist of numerous arterioles, venules and dilated capillaries in a thickened papillary dermis. Clinically, they present as 1–3 mm circular lesions of a uniform deep-red colouration and are not known to be associated with any other disease.2
TECHNIQUE
We have realised that Campbell de Morgan spots can act as useful indicators of flap perfusion. These lesions blanch or completely empty when pressure is applied. When the pressure is released, an obvious visible blush caused by the refill of the capillaries unequivocally demonstrates the status of the dermal microcirculation.
DISCUSSION
Although specifically designing flaps to incorporate Campbell de Morgan spots is impractical, we suggest that opportunistically including such a lesion may make monitoring flaps in the postoperative period much easier.
References
- 1.Jones NF. Intraoperative and postoperative monitoring of microsurgical free tissue transfers. Clin Plast Surg. 1992;19:783. [PubMed] [Google Scholar]
- 2.Odom RB, James WD, Berger TB. Andrew's Diseases of the Skin: Clinical Dermatology. 9th edn. Philadelphia, PA: WB Saunders; 2000. Dermal and subcutaneous tumors: cherry angiomas. [Google Scholar]