A factory worker sustains an avulsion injury where a large flap of skin is peeled back. The tissue viability of an avulsed flap is BEST when:

• A The flap is distally based (apex away from the direction of force)
• B The flap is of equal dimension in all directions
• C The flap has undergone full degloving with no attachment
• D The flap is proximally based (apex toward the body) ✓

Explanation

The vascular supply of skin runs predominantly in a proximal-to-distal direction through perforating vessels. A proximally based flap (pedicle toward the heart) retains its neurovascular supply at the base and is more likely to be viable for reattachment or healing. A distally based flap interrupts most of the arterial supply and is prone to ischaemic necrosis. This principle also guides reconstructive surgical flap design. In forensic practice, documenting flap orientation assists in reconstructing the direction of the injuring force.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.