Microsurgery for Cold Intolerance After Finger Replantation

Hussl, H.; Jungwirth, W; K, Hasenöhrl

doi:10.1016/s0140-6736(89)90943-4

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…14,36 Although the results showed use of the sensate cross-finger flap reduced the incidence of cold intolerance, this may not have a causal relation with our technique.…”

Section: Discussionmentioning

confidence: 78%

Treatment of Fingertip Degloving Injury Using the Bilaterally Innervated Sensory Cross-Finger Flap

Cc¹,

Tang²,

Zhang³

et al. 2014

Annals of Plastic Surgery

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Treatment of a fingertip degloving injury continues to be a challenge problem. This article reports repair of this type of injury using a modified cross-finger flap, including both dorsal branches of the digital nerves. From December 2007 to March 2010, the flap was used in 17 digits of 17 patients who had a fingertip degloving injury. There were 13 men and 4 women with mean age of 33 years. The injured fingers requiring reconstruction included 5 index, 6 middle, and 6 ring fingers. The mean size of the soft tissue losses was 4.2 × 1.9 cm. The mean flap size was 4.4 × 2.2 cm. Neurorrhaphy was performed between the dorsal branches harvested with the flap and the digital nerves of the injured finger. For comparison, we also collected a series of 28 patients who had a fingertip degloving injury treated with a cross-finger flap without nerve repair. In the study group, all flaps survived completely. At a mean follow-up of 23 months, the average score of static 2-point discrimination on the finger pulp was 7.2 mm. According to the visual analog scale, 12 patients had no pain, 4 reported mild pain, and 1 experienced moderate pain. Positive Tinel sign was found in only 1 reconstructed finger. Of the comparison group (mean follow-up, 22 months), the average static 2-point discrimination was 9.8 mm. On the basis of the visual analog scale, no pain, mild pain, and moderate pain were noted in 18, 7, and 3, fingers, respectively. Positive Tinel sign was found in 9 reconstructed fingers. The outcomes of the 2 groups were significantly different. The bilaterally innervated sensory cross-finger flap is an effective method for repairing the fingertip degloving injury. The authors suggest that double nerve repairs should be performed to improve the pulp sensation and reduce the incidence of the painful neuroma.

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“…14,36 Although the results showed use of the sensate cross-finger flap reduced the incidence of cold intolerance, this may not have a causal relation with our technique.…”

Section: Discussionmentioning

confidence: 78%

Treatment of Fingertip Degloving Injury Using the Bilaterally Innervated Sensory Cross-Finger Flap

Cc¹,

Tang²,

Zhang³

et al. 2014

Annals of Plastic Surgery

View full text Add to dashboard Cite

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“…[ 12 ] Thoracodorsal vessel implantation was proposed to treat cold intolerance because it is held to improve the vascularisation of severed digits. [ 5 ] Grafts from the superficial peroneal nerve were used to restore sensation before silicone rod implantation. The superficial peroneal nerve was harvested easily in the supine position, and the proximal stump remained subfascially deep in the leg, minimising the risk of painful neuroma formation.…”

Section: Discussionmentioning

confidence: 99%

“…The subscapular artery and one vein were anastomosed to the radial vessels laterally at the anatomic snuffbox, and the bundle was tunnelled subcutaneously to the radial side of the index finger [ Figure 2 ]. [ 5 ] The implanted muscle cuff received a skin graft. In addition, grafts from the superficial peroneal nerve were used to reconstruct gaps in the collateral nerves of the index and ring fingers.…”

Section: Case Reportmentioning

confidence: 99%

Algorithmic surgical enhancement of function after finger revascularisation

Landín

Bolado

Gajete

et al. 2016

Indian J Plast Surg

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Secondary surgical procedures can improve the function of revascularised and replanted digits. We describe the case of a patient who underwent multidigit revascularisation and replantation following a saw injury at flexor tendon Zone II. To achieve maximal functional improvement after finger revascularisation, we performed secondary surgical procedures in an order that was determined by following a reconstructive decision procedure that covered late revascularisation, nerve reconstruction, pedicled vascularised joint transfer, staged flexor tendon reconstruction and skin revision. Performing the procedures in this manner ensured overall safety. The patient's disabilities of the arm, hand and shoulder questionnaire score improved by 45 points, and the patient was able to return to work with an almost complete range of motion.

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Arterial Spasticity and Cold Intolerance in Relation to Time after Digital Replantation

Backman

Nyström

Bjerle

1993

Journal of Hand Surgery

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Cold induced arterial vasospasm was studied in ten patients with single digit replantation, by measuring finger systolic pressure at different finger temperatures. Each patient was examined three times; within 2 weeks of surgery, after 1 year and after 3 years. The replantations were performed using long arterial and venous grafts. Cold-related vasospasm is established during the first year after trauma, and thereafter seems to be persistent. It is concluded that the subjective cold tolerance, which affects all patients after digital amputation regardless of whether replantation is performed or not, is partly due to vasospasm. It is less pronounced in patients without pathological vasospasm in the replanted digit. Cold intolerance is likely to decrease during the first 2 years after replantation, but not to disappear completely.

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Microsurgery for Cold Intolerance After Finger Replantation

Cited by 10 publications

References 5 publications

Treatment of Fingertip Degloving Injury Using the Bilaterally Innervated Sensory Cross-Finger Flap

Treatment of Fingertip Degloving Injury Using the Bilaterally Innervated Sensory Cross-Finger Flap

Algorithmic surgical enhancement of function after finger revascularisation

Arterial Spasticity and Cold Intolerance in Relation to Time after Digital Replantation

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