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Cagnolati AF, Andrade FR, Serrano SDC, Barbieri CH, Mazzer N, Nogueira-Barbosa MH. Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler. Rev Bras Ortop 2022; 57:455-461. [PMID: 35785117 PMCID: PMC9246535 DOI: 10.1055/s-0041-1729574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 10/25/2022] Open
Abstract
Resumo
Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler.
Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento.
Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias.
Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.
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Affiliation(s)
- Amanda Favaro Cagnolati
- Residência Médica em Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Fernanda Ruiz Andrade
- Residência Médica em Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sara Dadona Correia Serrano
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Claudio Henrique Barbieri
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Nilton Mazzer
- Programa de Cirurgia de Mão, Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Marcello Henrique Nogueira-Barbosa
- Divisão de Radiologia, Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Feng SM, Zhao JJ, Migliorini F, Maffulli N, Xu W. First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes. J Orthop Surg Res 2021; 16:685. [PMID: 34794478 PMCID: PMC8600886 DOI: 10.1186/s13018-021-02838-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Shi-Ming Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.,Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Jia-Ju Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.
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Luo X, Yilihamu Y, Liu A, Huang Y, Ou C, Zou Y, Zhang X. Replantation and Lengthening of a Lower Leg in a 7-Year-Old Child: A Case Report. J Foot Ankle Surg 2019; 58:1273-1275. [PMID: 31679680 DOI: 10.1053/j.jfas.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/22/2019] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
Replantation of the lower leg has controversial indications, but it may be considered in carefully selected patients. Although the function of prosthetic lower legs has been improved in recent decades, leg salvage remains a laudable goal. We present the case of a 7-year-old child who sustained a traumatic amputation at the level of the middle tibia with loss of the middle portion of the lower leg. We performed successful replantation, and tibia lengthening was performed starting 10 days after replantation and lasted 6 months.
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Affiliation(s)
- Xuchao Luo
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yilizati Yilihamu
- Surgeon, Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anming Liu
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yu Huang
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Changliang Ou
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yonggen Zou
- Surgeon, Department of Hand Surgery, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xu Zhang
- Surgeon, Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Magistroni E, Ferriero G, Peri E, Parodi G, Massazza G, Franchignoni F. Psychometric properties of the Italian version of the Cold Intolerance Symptom Severity questionnaire in upper-extremity nerve repair. Eur J Phys Rehabil Med 2019; 55:627-633. [DOI: 10.23736/s1973-9087.19.05555-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Development of a simplified Cold Intolerance Symptom Severity questionnaire in patients with peripheral nerve injury. Int J Rehabil Res 2019; 42:63-67. [DOI: 10.1097/mrr.0000000000000328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lebowitz C, Matzon JL. Arterial Injury in the Upper Extremity: Evaluation, Strategies, and Anticoagulation Management. Hand Clin 2018; 34:85-95. [PMID: 29169600 DOI: 10.1016/j.hcl.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trauma to the upper extremity can present with an associated arterial injury. After patient stabilization, thorough assessment with physical examination and various imaging modalities allows accurate diagnosis of the specific arterial injury. After diagnosis, efficient treatment is necessary to allow limb salvage. Treatment options include ligation, primary repair, graft reconstruction, endovascular repair, and amputation. The final treatment rendered is frequently dependent on injury location and mechanism. With any of the treatment options, complications may occur, including thrombosis. Currently, no validated anticoagulation protocol has been established for managing arterial injuries in the upper extremity.
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Affiliation(s)
- Cory Lebowitz
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 080084, USA
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Schippers SM, Hajewski C, Glass NA, Caldwell L. Single Forearm Vessel Injury in a Perfused Hand: Repair or Ligate? A Systematic Review. THE IOWA ORTHOPAEDIC JOURNAL 2018; 38:159. [PMID: 30104940 PMCID: PMC6047372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The purpose of this study was to systematically review available literature reporting vessel patency and how this correlates with cold symptoms following the treatment of a single forearm artery injury when the hand remains perfused. The outcomes of those treated by ligation were compared to those treated with vessel repair. METHODS Electronic databases including PubMed, Embase (Elsevier) and Cochrane Central Register of Controlled Trials (Willey) were searched for studies that reported the outcomes of patients who underwent either ligation or repair of single vessel injuries to hands that remained perfused at time of presentation. Level of evidence was determined by two independent reviewers. Studies were then sorted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and application of inclusion and exclusion criteria. A total of 19 studies were included for statistical analysis. The patency of repaired vessels was calculated (with comparison between those with radial versus ulnar repair) as was the prevalence of cold symptoms in both ligation (or repairs that went on to occlusion) and repair groups. RESULTS The average patency of radial and ulnar artery repairs was 68.39% and 65.56% respectively. There was no significant difference between the success rates of these repair groups (pooled estimates for odd ratios was 1.02, p=0.867). The average incidence of cold symptoms in those who underwent ligation (or repair that when on to occlusion) and those that had patent repairs were 19.82% and 17.27% respectively. There was no significant difference between the incidence of cold symptoms between these groups (pooled estimate for proportion of patients with cold symptoms was 0.223, p=0.573). CONCLUSIONS This review showed there to be no significant difference in patency of isolated radial or ulnar artery repairs. There was also no significant difference in the prevalence of cold sensitivity in patients who underwent vessel ligation compared to those who underwent repair (and subsequently remained patent). These results support the conclusion of there being no clear benefit to attempting repair of a single vessel, although further studies are needed given the often incomplete reporting of clinical outcomes in this patient population. Additionally, though a cost-benefit analysis was not included in this review, exploring this aspect of the decision making process could be valuable.Level of Evidence: IV.
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Zhao G, Mi J, Rui Y, Pan X, Yao Q, Qiu Y. Correlation of volumetric flow rate and skin blood flow with cold intolerance in digital replantation. Medicine (Baltimore) 2017; 96:e9477. [PMID: 29390590 PMCID: PMC5758292 DOI: 10.1097/md.0000000000009477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cold intolerance is a common complication of digital replantation. The exact etiology is unclear, but it is considered to be multifactorial, including nonsurgical characteristics, vascular, and neurologic conditions. Blood flow may play a significant role in cold intolerance. This study was designed to evaluate the correlation of digital blood flow, including volumetric flow rate (VFR) and skin blood flow (SkBF), with cold intolerance in replanted fingers.A retrospective study was conducted among patients who underwent digital replantation between 2010 and 2013. Patients were selected into study cohort based on the inclusion criteria. Surgical data was collected on each patient, including age, sex, injury mechanism, amputation level, ischemia time, number of arteries repaired, and whether or not vascular crisis occurred. Patients were included as study cohort with both nerves repaired and without chronic disease. Cold intolerance was defined as a Cold Intolerance Symptom Severity (CISS) score over 30. The arterial flow velocity and caliber were measured by Color Doppler Ultrasound and the digital VFR was calculated. The SkBF was measured by Laser Speckle Imager. Both VFR and SkBF were calculated as a percentage of the contralateral fingers. Comparative study of surgical data and blood flow was performed between the patient with and without cold intolerance. Correlation between VFR and SkBF was also analyzed.A total of 93 patients met inclusion criteria for the study. Approximately, 42 patients were identified as having cold intolerance. Fingers that survived vascular crisis had a higher incidence of cold intolerance with a lower VFR and SkBF. The VFR was higher in 2-artery replantation, but the SkBF and incidence of cold intolerance did not differ significantly. No differences were found in age, sex, injury mechanism, amputation level, or ischemia time. Furthermore, no correlation was found between VFR and SkBF.Cold intolerance of digital replantation is associated with decreased SkBF and VFR in the replanted fingers, which survived vascular crisis. Further work will be focused on how vascular crisis cause the decreasing of SkBF and VFR and the increasing chance of cold intolerance.
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Affiliation(s)
- Gang Zhao
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Jingyi Mi
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Yongjun Rui
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Xiaoyun Pan
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Qun Yao
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Yang Qiu
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
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