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Le Hanneur M, Chaves C, Lauthe O, Salabi V, Bouché PA, Fitoussi F. Conventional versus fibrin-glue-augmented arterial microanastomosis: An experimental study. Hand Surg Rehabil 2022; 41:569-575. [PMID: 35988913 DOI: 10.1016/j.hansur.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this experimental study was to develop an alternative technique of arterial microanastomosis using only 2 stay-sutures augmented with fibrin glue, and to compare it to the conventional technique in arteries of varying diameters mimicking hand arteries. Eight anastomoses were performed in 7 male rats, including 1 anastomosis each on the 2 femoral, iliac, and carotid arteries, and 2 on the subrenal aorta. The conventional technique was used on one side and on the first aorta anastomosis, while augmented anastomoses were performed on the other side and on the second aorta. Patency was tested 10 min after unclamping; clamping time, blood loss, anastomosis quality score (out of 15 points) and artery diameter were recorded. In arteries of diameter 0.5-2.2 mm, augmented anastomoses were on average 10.7 ± 3.2 min faster to perform (p < 0.0001), with an average of 1.3 ± 0.9 g less blood loss (p < 0.0001) and an average of 2.6 ± 2.5 points higher quality score (p < 0.0001). There were no significant differences between the two techniques in terms of patency rate, regardless of artery size. However, 3 of the 7 augmented anastomoses were non-permeable in the femoral subgroup (i.e., submillimetric arteries). This straightforward technique appears to be time-saving and reliable, provided that the repaired artery is of sufficient size. Subject to clinical validation, this technique might help surgeons treating extensive hand wounds with multiple severed neurovascular bundles.
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Affiliation(s)
- M Le Hanneur
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France; Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
| | - C Chaves
- Unité de Chirurgie de la Main, Clinique du Pré, 13 avenue René Laennec, 72000 Le Mans, France.
| | - O Lauthe
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France.
| | - V Salabi
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France.
| | - P-A Bouché
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
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Poli F, Fortier C, Khettab H, Faita F, Vitali S, Aringhieri G, Ghiadoni L, Taddei S, Amar L, Lorthioir A, Boutouyrie P, Bruno RM. Validation and Feasibility of an Automated System for the Assessment of Vascular Structure and Mechanical Properties in the Digital Arteries: An Ultrahigh-Frequency Ultrasound Study. Ultrasound Med Biol 2022; 48:711-716. [PMID: 35058069 DOI: 10.1016/j.ultrasmedbio.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/02/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
Ultrahigh-frequency ultrasound (UHFUS) allows sharp visualization of human small muscular arteries. This may help in elucidating some aspects of the pathophysiology of arterial aging, such as the stiffness gradient between large and small conduit arteries and its consequences on the microcirculation, as well as vascular diseases affecting medium-sized arteries. However, UHFUS use is still limited, partly because of the lack of validated tools to quantify vascular structure and mechanical properties of small muscular arteries. In this validation study, scans of digital arteries were obtained with UHFUS (VevoMD, Visualsonics-Fujifilm, Toronto, ON, Canada), analyzed using Carotid Studio software (Quipu, Pisa, Italy) and compared with the manual measurement. Agreement between the two techniques on measures of diameter, distension and intima-media thickness (IMT) was evaluated using Bland-Altman analyses; inter- and intra-operator reproducibility was evaluated using coefficients of variation (CVs). Overall, no trend or significant bias was observed between Carotid Studio and manual analysis. All limits of agreement were acceptable. The intra-observer CV of diastolic diameter and IMT were 4.1% and 4.2%, respectively. The inter-observer CV for diastolic diameter and IMT were 7.3% and 5.4%, respectively. Intra- and inter-observer CVs for distension were higher (25.7% and 26.7%, respectively). These results suggest that the Carotid Studio software is a valid and reproducible tool to study UHFUS scans of digital arteries, with potential utility both in rare vascular diseases of medium-sized arteries and in the study of the pathophysiology of arterial aging in general.
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Affiliation(s)
- Federica Poli
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-970, and Université de Paris, Paris, France
| | - Catherine Fortier
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-970, and Université de Paris, Paris, France
| | - Hakim Khettab
- AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | | | | | - Laurence Amar
- AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Aurelien Lorthioir
- AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Pierre Boutouyrie
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-970, and Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Rosa Maria Bruno
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-970, and Université de Paris, Paris, France; AP-HP, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France.
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Morimoto Y, Sogabe Y, Kawabata A, Takamatsu K. Digital artery perforator flap transfer for volar soft tissue defect due to dissociation from joint contracture in camptodactyly. JPRAS Open 2020; 27:48-52. [PMID: 33319010 PMCID: PMC7726480 DOI: 10.1016/j.jpra.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022] Open
Abstract
Camptodactyly is a condition defined by persistent flexion contracture of the proximal interphalangeal joints of the hand. Surgical treatment requires flaps for the dissection of the skin and the resulting soft tissue defect, soft tissue release, and sometimes reconstruction of the extension mechanism. Z-plasty and transposition flap have been reported as methods used in soft tissue defects. In this case, covering the defects of the digits was necessary for keeping the wound clean; thus, we should select a surgical method that facilitates stable and reliable blood flow of the flap. The digital artery perforator flap is pedicled and its transfer does not require the dissection of neurovascular bundles; therefore, it can be used safety and relatively easily. We considered the digital artery perforator flap to be a useful technique in terms of securing stable and reliable blood flow and not twisting the skin. Thus, we performed a digital artery perforator flap transfer for a volar soft tissue defect due to dissociation from proximal interphalangeal joint contracture in camptodactyly.
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Linnaus ME, Langlais CS, Kirkilas M, Muenzer JT, Zoldos J, Graziano K, Notrica DM. Outcomes of digital artery revascularization in pediatric trauma. J Pediatr Surg 2016; 51:1543-7. [PMID: 27156104 DOI: 10.1016/j.jpedsurg.2016.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Digit amputation is rare in pediatric trauma but can lead to functional morbidity. The true incidence of digital arterial injury is lacking in the literature, and revascularization techniques are not well-described. METHODS Retrospective review of a pediatric trauma registry identified patients with a digital artery injury between July 2008 and December 2013. Isolated vein injuries and arterial injuries proximal to the digits were excluded. Descriptive statistics were used. RESULTS Twenty-five subjects met inclusion. Most were male (n=16; 64%) and the median age was 6.8 (IQR: 2.8, 11.1) years. The most common blunt (n=12) trauma was struck/crushed by object (n=4; 33%) and the most common penetrating (n=13) trauma was because of glass (n=9; 69%). All subjects were managed operatively. Initial operations for arterial repair were primary arterial repair (15; 20%), vein graft (7; 28%), thrombectomy (1; 4%), and amputation (1; 4%). Twelve patients (48%) had reported complications at initial follow-up, but only two (8%) had long-term (>24weeks) sequelae. CONCLUSION Digital artery injury is rare among pediatric traumas. Functional outcomes after digital artery revascularization are favorable. Primary repair can successfully manage these injuries and vein grafting appears to be a suitable alternative when primary repair is not feasible.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Surgery, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, USA, 85054
| | - Crystal S Langlais
- Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016
| | - Mary Kirkilas
- Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016
| | - Jared T Muenzer
- Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA, 85004
| | - Jozef Zoldos
- Arizona Center for Hand Surgery, 370 E Virginia Ave, Suite 100, Phoenix, AZ, USA, 85004
| | - Kathleen Graziano
- Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA, 85004
| | - David M Notrica
- Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA, 85004; Department of Surgery, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, USA, 85054.
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Shintani K, Takamatsu K, Uemura T, Onode E, Okada M, Kazuki K, Nakamura H. Planning digital artery perforators using color Doppler ultrasonography: A preliminary report. J Plast Reconstr Aesthet Surg 2016; 69:634-9. [PMID: 26947673 DOI: 10.1016/j.bjps.2016.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/19/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
Abstract
Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.
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Düzgün S, Ozdemir A, Unlü E, Pekdemir I, Yılancı S, Alhan B. The intraneural hemangioma of the digital nerve: case report. J Hand Microsurg 2013; 5:27-9. [PMID: 24426668 DOI: 10.1007/s12593-011-0059-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022] Open
Abstract
Intraneural Hemangioma of the digital nerve is rare and so far three cases have been reported in the literature. We present a case of 12- year- old boy with painless soft tissue mass in the right hand and numbness on the radial aspect of the index finger. Magnetic Resonance Imaging showed an isointense subcutaneous lesion without discrete borders in the first web space classically of hemangioma with the radial digital nerve extension. On exploration, the intraneural extension of the hemangioma was confirmed and total resection, microsurgical primary digital nerve repair was done. The patient became better and at 6 months follow up the index finger sensation improved. The patient had no reccurence and he is still under follow up.
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