The Pinprick Test: Key Considerations in Execution of Skin Flap Perfusion Testing

摘要

Effective pinprick test, a method of testing skin free flap perfusion, is essential to establish and confirm blood inflow in free tissue transfer. Free flap monitoring is essential and comprises several methods, specifically, Acland test for the microvascular anastomoses and clinical bedside evaluations based on skin flap colour, capillary refill time, flap temperature, tissue turgor and texture, and peripheral bleeding on pinprick testing. , Novel methods using the gold standard traditional bedside assessment, pinprick testing, combined with indocyanine green (ICG) near-infrared angiography has been reported to be useful in evaluating the distribution of flap blood flow. , The combined ICG-pinprick flap perfusion test demonstrated effective perfusion-related outcomes in intra-oral free flaps monitoring; however, the effectiveness in execution of the pinprick test may have divergent outcomes in inexperienced hands. Especially during flap congestion, troubleshooting, or when ICG-pinprick test is performed in a very brightly perfused area. We describe some key considerations during execution of the pinprick test, in the attempt to eliminate technical performance doubts when skin free flap distal perfusion is equivocal.