Objective To study the changes of endothelin (ET) and nitric oxide (NO) in the local site of vein transfer with delayed breaking pedicle and the relation with vasospasm and vein transfer in rabbits. MethodsThe ET concentration of blood was determined with the radioimmunoassay method. The plasma NO-2,NO-3 levels in the local site of vein transfer with delayed breaking pedicle, which reflected NO levels indirectly, were detected with Ultravioletvisible (UvVIS ) spectrophotometer. ResultsThe endothelin concentration of blood was increased significantly at 2, 4 hour after the operation (P＜0.01), and at 8 hour after the operation (P＜0.05). The plasma NO level was significantly decreased at 2, 4 hour after the operation (P＜0.01). But at 24 hour after the operation, the plasma NO level was increased significantly (P＜0.05). Conclusion The recovery of ET concentration of blood and the increase of plasma NO at 24 hour after the operation are the cause of the reduced incidence of vascular crisis of vein transfer with delayed breaking pedicle, and the very time point is the optimum moment for pedicle breaking.
Objective To explore the effect and mechanism of ultrashort wave (USW) for prevention and treatment of vascular crisis after rat tail replantation. Methods Eighty 3-month old female Sprague Dawley rats (weighing 232.8-289.6 g) were randomly divided into 5 groups. In each group, based on the caudal vein and the coccyx was retained, the tail was cut off. The tail artery was ligated in group A; the tail artery was anastomosed in groups B, C, D, and E to establish the tail replantation model. After surgery, the rats of group B were given normal management; the rats of group C were immediately given intraperitoneal injection (3.125 mL/kg) of diluted papaverine hydrochloride injection (1 mg/mL); the rats of groups D and E were immediately given the local USW treatment (once a day) at anastomotic site for 5 days at the dosage of 3 files and 50 mA for 20 minutes (group D) and 2 files and 28 mA for 20 minutes (group E). The survival rate of the rat tails was observed for 10 days after the tail replantation. The tail skin temperature difference between proximal and distal anastomosis was measured at pre- and post-operation; the change between postoperative and preoperative temperature difference was calculated. The blood plasma specimens were collected from the inner canthus before operation and from the tip of the tail at 8 hours after operation to measure the content of nitric oxide (NO). Results The survival rates of the rat tails were 0 (0/14), 36.4% (8/22), 57.1% (8/14), 22.2% (4/18), and 75.0% (9/12) in groups A, B, C, D, and E, respectively, showing significant overall differences among 5 groups (χ2=19.935, P=0.001); the survival rate of group E was significantly higher than that of group B at 7 days (P lt; 0.05), but no significant difference was found between the other groups by pairwise comparison (P gt; 0.05). At preoperation, there was no significant difference in tail skin temperature difference among 5 groups (P gt; 0.05); at 8 hours, 5 days, 6 days, and 7 days after operation, significant overall difference was found in the change of the skin temperature difference among groups (P lt; 0.05); pairwise comparison showed significant differences after operation (P lt; 0.05): group B gt; group D at 8 hours, group C gt; group D at 5 days, groups A, B, and C gt; group D at 6 days, groups B and C gt; groups A and E, and group B gt; group D at 7 days; but no significant difference was found between the other groups at the other time points (P gt; 0.05). Preoperative plasma NO content between each group had no significant difference (P gt; 0.05). The overall differences had significance in the NO content at postopoerative 8 hours and in the change of the NO content at pre- and post-operation among groups (P lt; 0.05). Significant differences were found by pairwise comparison (P lt; 0.05): group D gt; groups A, B, and C in the plasma NO content, group D gt; groups A and B in the change of the NO content at pre- and post-operation; but no significant difference was found between the other groups by pairwise comparison (P gt; 0.05). Conclusion Rat tail replantation model in this experiment is feasible. USW therapy can increase the survival rate of replanted rat tails, reduce skin temperature at 7 days, improve blood supply, increase the content of nitric oxide at the early period and prevent vascular crisis.
In order to find out the causes, diagnosis, and the prevention and treatment of vascular crisis following anastomosis of small vessels, 314 cases vascular crisis from 1985 to 1997, were analyzed, in which 152 cases, suffered from tissue necrosis either total or partial, making up 48.4%. One hundred and forty-four cases underwent conservative treatment occupying 45.8% and 104 cases had tissue necrosis, occupying 68.4%. Operative exploration was done on 170 cases, occupying 54.1% and 48 cases of them suffered from necrosis, which made up 31.6% of all necrotic cases. Eighty-six cases were followed up by regular visits, ranging from 40 days to 7 years, with the finding that those who had regained normal circulation after vascular crisis recovered as well as those without crisis, and among those who did not regain normal circulation but survived with the help of collateral circulation after vascular crisis, they were usually cases of bad union, healing of wound, persistent swelling, different degree of tissue atrophy, poor recovery of sensation. It was concluded that proper use of vascular anastomosis technique and prophylactic measures preventing postoperative vascular spasm were extremely important, in the prevention of development of vascular crisis following anastomosis of small vessels. If vascular crisis did not respond well to conservative treatment, prompt surgical exploration should be undertaken.
目的 探讨末梢灌注指数（TPI）在断指再植术后对血管危象早期诊断的价值。 方法 对2005年1月－2011年10月31例36个再植指运用Agilent V24C监护仪血氧饱和度探头进行持续TPI监测，同时观察记录术后再植指皮温、色泽、肿胀程度及毛细血管搏动情况，将发生血管危象的再植指分为危象组（n=4），将未发生血管危象的再植指分为对照组（n=32），分析发生危象前12 h至危象发生时的TPI，每2小时为一时间段，共7个时相，分别记为T1~T7。 结果 对照组各时间点TPI无明显变化，各时间点比较差异无统计学意义（P＞0.05）；危象组从T4开始，TPI呈逐渐下降趋势，与前一时间点比较差异均有统计学意义（P＜0.05）。两组TPI在T1、T2、T3时比较差异无统计学意义（P＜0.05）；从T4开始，危象组TPI均较对照组降低，差异有统计学意义（P＜0.05）。 结论 TPI监测能够无创、实时、灵敏地反映断指再植术后再植指血供情况，可早于临床症状以前对断指再植术后血管危象作出诊断，有较高的临床应用价值。
ObjectiveTo observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography (DSA) medical imaging detection system. MethodFrom July 2014 to July 2015, 342 patients were classified into gradeⅠ and gradeⅡ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy. ResultsCompared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group (P<0.017) . ConclusionsThe 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients' anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate of replanted fingers and facilitating early rehabilitation of their function.
Objective To explore the causes of vascular crisis after thumb and other finger reconstruction by toe-to-hand transfer and effective treatment methods so as to improve the survival rate of transplanted tissues. Methods Between February 2012 and October 2015, 59 cases of thumb and other finger defects were repaired with different hallux nail flaps with the same vascular pedicle flap to reconstruct thumb and other fingers and repair skin defect. The donor site was repaired by a perforator flap. A total of 197 free tissues were involved. There were 46 males and 13 females with the average age of 30.6 years (range, 18-42 years). Vascular crisis occurred in 21 free tissues (10.7%) of 17 patients, including 9 arterial crisis (4.6%) of 8 cases, and 12 venous crisis (6.1%) of 10 cases. Conservative treatment was performed first; in 8 free tissues of 7 cases after failure of conservative treatment, anastomotic thrombosis was found in 5 free tissues of 4 cases, twisted vascular pedicle in 1 free tissue of 1 case, surrounding hematoma in 1 free tissue of 1 case, and anastomotic thrombosis associated with hematoma in 1 free tissue of 1 case, which underwent clearing hematoma, resecting embolization, regulating vascular tension, re-anastomosis or vascular transplantation. Results In 8 cases of arterial crisis, 5 free tissues of 5 cases survived after conservative treatment; partial necrosis occurred in 1 free tissue (1 case) of 4 free tissues (3 cases) undergoing surgical exploration. In 10 cases of venous crisis, 1 free tissue necrosis and 1 free tissue partial necrosis occurred in 8 free tissues (6 cases) undergoing conservative treatment; partial necrosis occurred in 1 free tissue of 4 free tissues (4 cases) undergoing surgical exploration. Free flap and skin graft were performed on 2 free tissues of 4 cases having flap necrosis respectively. Conclusion Vascular crisis is complex and harmful to survival of transplanted tissue in reconstruction of the thumb and other fingers. Immediate intervention is helpful to obtain a higher survival rate.
Objective To explore the clinical application and effect of infrared thermal imager in blood flow monitoring after skin flap surgery by comparing with skin-contact thermometer. Methods Fifty patients who had undergone flap repair in the microsurgery ward of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and October 2020 were enrolled. An infrared thermal imager (FLIR ONE Pro) and a skin-contact thermometer were applied to monitor the skin temperature change till 7 d after surgery. The time consumed of using infrared thermal imager and skin-contact thermometer by different nurses, the efficacy of flap temperature monitoring of the two devices, the temperatures at different time points by using the two devices, and the temperatures under different distances to the flaps by using infrared thermal imager were compared. Results Different nurses had no difference in operating either of the two devices (P>0.05). It took significantly less time to measure the temperature of the flap area with the infrared thermal imager than using skin-contact thermometer [(39.28±3.52) vs. (103.85±9.09) s, P<0.001]. The skin temperature measured by the infrared thermal imager was significantly higher than that by the skin-contact thermometer (P<0.001), and the skin temperature measured by the infrared thermal imager at a height of 30 cm was higher than that at a height of 50 cm (P=0.006), but the temperature change amplitudes were both stable. Conclusions Infrared thermal imager is superior to skin-contact thermometer in terms of temperature measurement time, ease of operation, and sensitivity to temperature changes after skin flap operations. The thermal image collected by infrared thermal imager can provide an important basis for the identification of flap vascular crisis. It is a visual and objective blood supply monitoring equipment.