when to muscle flap?

[bebop1]

I was told by a nurse to let the MD know when a patients wound was ready for a muscle flap. the patient has bilateral isch tub wounds on a wound vac. they are doing well, and progressing wonderfully. How, or what criteria am I supposed to look at to let the md know that this patient is ready for muscle flap surgery on these wounds?

I really do not know how that surgery will work for this patient, but what do I look for ...or what other information do you need from me to help me determine this for the md? I work in a LTC facility and the MD does not want to see him until ready for muscle flap surgery? what do I do?

thanks!!!

[KimT08]

My first question is why would this resident need a muscle flap if the wounds are progressing well with a wound vac? There are several factors you must consider prior to deciding if it is time for the flap. First of all this is never a nurses call however I will give you a few things that the surgeon might ask being that I have worked closely with several different surgeons. The first thing is the resident's nutritional status good. You would need prealbumin, albumin, and total protein levels. If these labs are within normal limits then the resident is probably well nourished. If these labs are low then it would be a red flag for the flap. Secondly are there any signs or symptoms of infection or colonization of the wound i.e. malodorous drainage, heavy drainage, unhealthy wound bed, etc. If there are any signs or symptoms then it would be another red flag. What type of bed does this person have? Typically all patients/residents who undergo a muscle flap procedure require at least 6 weeks on a Clinitron bed post op. Is that possible for this resident? If not the surgeon considering the flap needs to be informed of that because it may influence his decision. Next thing to consider is the resident's general medical condition. These are just a few very important things that should be considered and relayed to the surgeon considering the flap before he makes the decision to proceed. Any surgeon that I have worked with would not proceed with a flap if the resident/patient was making progress with a less aggressive treatment. I hope this helps.