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The flap usually is designed longer and wider than is expected to be crucial. The Crane principle is an idea related to prefabrication. Delaying the flap can also increase the length that may be efficiently transferred. In this course of, increase the flap in 2 levels instead of 1, permitting approximately 7-14 d between the 2 procedures. Dissect or divide the flap partially, leaving some blood supply intact, and depart it in its native mattress. Theories explaining the delay phenomenon embrace vasodilation brought on by the sympathectomy and a hyperadrenergic state lasting 18-36 h after a flap is raised. Nonetheless, this period of vasoconstriction does not occur at the second stage. After profitable flap design and implementation, monitor the flap for viability as early recognition of ischemia is essential in preventing subsequent flap necrosis, thus flap failure. Clinical observation is the best technique to assess a flap. A particularly pale flap could signify arterial insufficiency, whereas a blue flap could also be secondary to a failure of venous outflow. Two further checks often used to assess viability are capillary refill and warmth.

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