Influence of the level of arterial resection on the replanting and revascularization results in hand surgery : prospective study over 22 months
Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved..
The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
|---|---|
| Enthalten in: |
Hand surgery & rehabilitation - 40(2021), 5 vom: 06. Okt., Seite 660-669 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Regas, I [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 01.04.2022 Date Revised 01.04.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.hansur.2021.06.002 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM326595554 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM326595554 | ||
| 003 | DE-627 | ||
| 005 | 20231225194931.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.hansur.2021.06.002 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1088.xml |
| 035 | |a (DE-627)NLM326595554 | ||
| 035 | |a (NLM)34111576 | ||
| 035 | |a (PII)S2468-1229(21)00164-X | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Regas, I |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Influence of the level of arterial resection on the replanting and revascularization results in hand surgery |b prospective study over 22 months |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.04.2022 | ||
| 500 | |a Date Revised 01.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Analyse histologique | |
| 650 | 4 | |a Anastomose artérielle | |
| 650 | 4 | |a Arterial anastomosis | |
| 650 | 4 | |a Arterial wound | |
| 650 | 4 | |a Histological analysis | |
| 650 | 4 | |a Plaie artérielle | |
| 650 | 4 | |a Replantation | |
| 650 | 4 | |a Replanting | |
| 650 | 4 | |a Revascularisation | |
| 650 | 4 | |a Revascularization | |
| 700 | 1 | |a Saizonou, I |e verfasserin |4 aut | |
| 700 | 1 | |a Pichonnat, M |e verfasserin |4 aut | |
| 700 | 1 | |a Menez, C |e verfasserin |4 aut | |
| 700 | 1 | |a Menu, G |e verfasserin |4 aut | |
| 700 | 1 | |a El Rifai, S |e verfasserin |4 aut | |
| 700 | 1 | |a Echalier, C |e verfasserin |4 aut | |
| 700 | 1 | |a Boyer, E |e verfasserin |4 aut | |
| 700 | 1 | |a Loisel, F |e verfasserin |4 aut | |
| 700 | 1 | |a Aubry, S |e verfasserin |4 aut | |
| 700 | 1 | |a Obert, L |e verfasserin |4 aut | |
| 700 | 1 | |a Feuvrier, D |e verfasserin |4 aut | |
| 700 | 1 | |a Pluvy, I |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Hand surgery & rehabilitation |d 2016 |g 40(2021), 5 vom: 06. Okt., Seite 660-669 |w (DE-627)NLM259761184 |x 2468-1210 |7 nnns |
| 773 | 1 | 8 | |g volume:40 |g year:2021 |g number:5 |g day:06 |g month:10 |g pages:660-669 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.hansur.2021.06.002 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 40 |j 2021 |e 5 |b 06 |c 10 |h 660-669 | ||