Certified Wound Ostomy Nurse (CWON) Practice Test

Which condition indicates ischemia in a myocutaneous flap?

1. Dark red coloring of the flap

2. Pallor or cyanosis in the flap area

3. Increased warmth around the flap

4. Rapid capillary refill time

The correct answer is: Pallor or cyanosis in the flap area

Ischemia in a myocutaneous flap is primarily indicated by pallor or cyanosis in the flap area. This change in color reflects inadequate blood supply to the tissue, which can occur as a result of compromised vascularity. When tissues do not receive sufficient oxygenated blood, they exhibit pallor due to a lack of hemoglobin in the blood or cyanosis, where the tissue takes on a bluish tint as deoxygenated hemoglobin becomes more prominent. A dark red coloring of the flap can suggest congestion rather than ischemia, indicating that there might be too much blood accumulating in an area rather than lack of blood flow. Increased warmth around the flap is typically associated with increased blood flow, which would not be indicative of ischemia. Rapid capillary refill time demonstrates good perfusion and adequate blood supply, negating the idea of ischemia. Therefore, observing pallor or cyanosis is a critical clinical sign that signifies potential ischemic changes in the flap, making it essential for monitoring and management in flap surgeries.