Patterns of thermoregulation associated with cold intolerance after digital replantation

Abstract

Twelve patients with complete thumb amputations were analyzed to determine the interrelations between thermoregulation for pain and cold intolerance and sensory nerve recovery. Patients were examined at 3 months, 6 months, 1 year, and after 2 years following replantation. Medical thermography was introduced to assess postoperative circulation following digital replantation, while vasomotor tone was assessed by cold-stress plethysmography testing. Postoperative circulation was divided into two different patterns based upon skin temperature, the transition of which over time correlated well with sensory nerve recovery. Patients with cold intolerance showed a persistent vasoconstriction pattern, the cold change of which was objectively detected by thermography.

Infrared thermography: Experience from a decade of pediatric imaging

“…Thermography allows the direct assessment of the viability of the re-implanted digit and gives immediate information about the success of revascularization. In larger studies after long-term followup in children, IRT was also used to objectively evaluate the postoperative circulation along with patterns of thermoregulation associated with cold intolerance after digital re-implantation [11]. Assessment of burn-related injuries using IRT was recognized almost 3 decades ago [9].…”

Rewarming Patterns in Hand Fracture Patients With and Without Cold Intolerance

“…[1][2][3][4][5][6][7][8] In a study on patients with a hand fracture, the prevalence of cold intolerance was found to be 38%. In addition, cold intolerance is commonly reported by patients who have had Raynaud's disease, 9 -12 upper extremity trauma, digital replantations, [13][14][15][16][17][18][19][20][21][22] hand and arm vibration syndrome, and a radial forearm flap. 23,24 In many studies, the presence of cold intolerance is determined using a single yes/no question.…”

“…1 Nevertheless, it is assumed that cold intolerance is related to vascular dysfunction. 18 In a healthy person, after extensive cooling of the extremity, the thermoregulatory system increases the blood flow to the extremity to counteract the decrease in hand temperature and prevent pain and/or frostbite. 26 One of the substances involved in this thermoregulatory process is nitric oxide (NO), which has a direct effect on the smooth muscle activity.…”

Digital Rewarming Patterns After Median and Ulnar Nerve Injury

“…11,15,16,18 Cold intolerance has been found to be the most disabling symptom following peripheral nerve injury, and it does not diminish over time. 11,13,15,18 -21 Cold intolerance has also been noticed frequently in patients with Raynaud's disease, [22][23][24][25] upper extremity fractures, 26 digital replantations, 21,[27][28][29][30][31][32][33][34][35] and after raising radial forearm flaps. 36,37 The severity of CI has been studied subjectively using a single question, 16,30,38 interviews, 10,17,29,39 questionnaires, 13,18,[32][33][34] and validated questionnaires such as the McCabe 12,[18][19][20]40 and the Blond McIndoe CISS.…”

“…36,37 The severity of CI has been studied subjectively using a single question, 16,30,38 interviews, 10,17,29,39 questionnaires, 13,18,[32][33][34] and validated questionnaires such as the McCabe 12,[18][19][20]40 and the Blond McIndoe CISS. 11,15 In patients exposed to vibration tools (e.g., forestry workers, construction workers), Raynaud's disease, complex regional pain syndrome, or digital replantations and amputations, several laboratory tests have been used to study digital blood flow and skin temperature, for example, laser Doppler flowmetry, 31,40 -47 plethysmography to measure the amount of blood inflow, 27,34,43 finger systolic blood pressure, 26,33,48 -50 thermocouples on the skin, 4,44,45,51,52 and infrared thermography. 23,36,43,[53][54][55][56][57][58][59] However, to our knowledge, rewarming has been evaluated in nerve injury patients only by Ruch 40 in recent injuries (Ͻ3 months old) using laser Doppler flowmetry and thermocouples and by Pulst 59…”