We read the article entitled “Using Duplex Ultrasound for Recipient Vessel Selection.” by Hong JP, et al. with great interest. 1 They reported that Duplex ultrasound (US) could be a reliable tool for reconstructive surgeons to choose recipient vessels. Since the introduction of new types of flaps such as the perforator-to-perforator flap and superthin flap, detailed evaluation of the vascularity of flap and recipient vessels gets more and more essential and various kinds of US could be applied for preoperative evaluation. US examination is safe for patients, easy to perform, doesn’t take much time, and detects very small vessels with a diameter of 0.5 mm. 2 Moreover, at our hospital Doppler US could also be applied to prevent vascular spasms during rehabilitation after finger or hand replantation. Many hand surgeons kept Replanted fingers immobilized for 5 to 7 days after fingers and hand replantation. 3 One of the reasons for this immobilization was that movement of the fingers might cause spasms or thrombosis of anastomotic vessels and lead to necrosis of tissues. However, delayed rehabilitation could cause adhesion of flexor and extensor tendon and joint contractures, and lead to impairment of hand function. Therefore, early mobilization of fingers accompanied with assessments of arterial patency is very important in the field of rehabilitation of finger and hand replantation. To overcome this challenge, we used Doppler US for the assessment of the blood flow of anastomotic vessels during the extension and flexion of joints near the anastomotic area.

Study Design: Retrospective study.Purpose: This research aimed to assess the clinical outcomes of patients with traumatic cervical spine dislocation who underwent closed reduction employing our approach.Overview of Literature: Bedside closed reduction is the quickest procedure for repairing traumatic cervical spine dislocations; nevertheless, it also possesses the risk of neurological deterioration.Methods: For closed reduction, the patient’s head was elevated on a motorized bed, the cervical spine was placed at the midline, traction of 10 kg was applied, the motorized bed was gradually returned to a flat position, the head was lifted off the bed, and the cervical spine was slowly adjusted to a flexed position. The weight of traction was elevated by 5-kg increments until the positional shift was attained. Subsequently, the bed was gradually tilted while traction was applied again to return the cervical spine to the midline position.Results: Of the 43 cases of cervical spine dislocation, closed reduction was carried out in 40 cases, of which 36 were successful. During repositioning, three patients experienced a temporary worsening of their neck pain and neurological symptoms that enhanced when the cervical spine was flexed. Closed reduction was conducted while the patient was awake; nevertheless, sedation was needed in three cases. Among the 24 patients whose pretreatment paralysis had been characterized by American Spinal Injury Association Impairment Scale (AIS) grades A–C, seven patients (29.2%) demonstrated an enhancement of two or more AIS grades at the last observation.Conclusions: Our closed reduction approach safely repaired traumatic cervical spine dislocations.

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