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Closed digital artery injury diagnosis and treatment of_4414

By Susan Simpson,2014-10-30 11:19
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Closed digital artery injury diagnosis and treatment of_4414

Closed digital artery injury diagnosis and treatment of

     Abstract Objective To investigate the use of blunt injury of artery blood vessel grafting is feasible. Methods by June 2003 to May 2008 28 cases of closed artery injury cases with the mean vascular grafts to

    repair damaged arteries, concluded that arterial injury in blunt diagnosis and treatment. Results 28 cases of post-operative survival in 27 cases,

    the survival rate of 96.4%. The average follow-up of 12 months, using the

    International Federation of Hand Surgery Nako-mura tamal evaluation

    criteria, excellent in 18 cases, good in 8 cases, 1 case of failure in 1 case, the fine rate was 92.8%. Conclusion diagnosed as closed artery injuries should be actively treated, early surgical exploration, use of

    vascular injury artery grafting. Segment of the injury to determine the blood vessels, vascular graft surgery, as well as post-operative care is

    very important.

     Key words artery injury in blunt trauma diagnosis and treatment of vascular graft

     Abstract Objective To explore the feasibility of repairing the closed injured arteries by vascular grafting. Methods Retrospective study was performed to the 28 cases of closed injury of digital arteries that were repaired by vascular grafting from June 2003 to May 2008. Result 27 of the 28 cases survived, and the survival rate was 96.4%. 28 cases were followed up, the average time was 12 months. The evaluation of the results was based on the Nako-mura tamal standard set by International Federational of

    Societies for Surgery of the Hand (IFSSH). And the result was excellent in 18 cases, good in 8, eligible in 1, fail in 1. The excellent rate was 92.8%. Conclusion Patients who were diagnosed as the closed injury of digital arteries should be treated actively, surgical exploration should

    be performed and the injured arteries should be repaired by vascular grafting as soon as possible. The judge of the segment of injured vessles, the vascular grafting during the operation, and the postoperative care are

    of great importance.

     Key words Closed injury Digital artery injury Vasotransplantation Diagnosis Treatment of closed artery injuries are not uncommon in clinical

    practice, but often lead to misdiagnosis, and if not handled properly will often result in necrosis of the fingers [1]. Undergraduate from June 2003 to April 2008 Closed digital artery injury were treated 28 patients by preoperative physical examination and color Doppler ultrasound diagnosis of emergency, using micro-surgical method of duct exploration, the use of

    forearm superficial venous Graft artery, results were satisfactory. These are as follows.

     A clinical data

     1.1 General information on this group of 28 cases, 19 males and 9 females, aged 8 to 47 years (mean 28.3 years); wooden injured after 8

    cases, 7 cases weight crushing, rope steel Kessler injury in 5 cases, punch hit 6 cases of injury, boxing injuries in 2 cases. In 2 cases in which the thumb, index finger 12 cases, 7 cases of the middle finger, ring finger in 5 cases, the little finger in 2 cases; combined injury associated with fracture in 9 cases, with three cases of rupture that nerve; 25 cases of a different level, a nerve contusion (skin wounds that are incomplete). 28 cases, 17 cases of repair bilateral artery, 11 cases

    of fixed edge side of that artery, are used forearm superficial vein graft.

     1.2 Diagnosis based on closed artery injury is generally diagnosed by physical examination findings of the main manifestations are: (1) injury distal pulp arteries on both sides of that line-line row routes

    ecchymosis; (2) injury beyond the finger skin temperature is low, capillary reflux slowly. Doppler ultrasound can be diagnosed through blood vessels and blood flow interruption of embolization [1].

     1.3 Treatment surgery under brachial plexus anesthesia, intraoperative application of tourniquet pressure, bone fracture, first for fracture fixation. A prominent place in the pulp to make the lateral ecchymosis Z-incision, exposure means the artery and nerve damage that can

    be found in arteries, and can see the formation of thrombosis, intraoperative segmental vessels cut off damage to normal position. At this point, due to defects in blood vessels, can not directly match, should take the forearm superficial vein graft for repair of finger

    artery. At the same time the merger means the Neurotmesis who refers to nerve repair. Within 1 week after operation in patients with absolute bed rest, local heat lamp warm, as well as anti-inflammatory, anticoagulant,

    anti-spasm and other therapy, strict blood supply outlook check fingertips. 3 ~ 4 weeks after rehabilitation exercises. Smoking at 12 weeks [2].

     2 Results

     28 cases in this group survived in 27 cases, the survival rate was

    96.4%, postoperative arterial crisis occurred in 2 cases, of which 1 case was flat limbs, using papaverine, urokinase therapy to alleviate the other 1 case was not apparent after surgical exploration improvement after Distal necrosis. Minimum follow-up of 4 months, a maximum of 32 months

    (mean 12 months) [3], using the International Federation of Hand Surgery Nako-mura tamal evaluation criteria, excellent in 18 cases, good in 8 cases, 1 case of failure in 1 case, excellent rate of 92.8%. Was good in that body shape, functional recovery were good sensory recovery up to S 4, distal pulp full. Reposted elsewhere in the paper for free download http://

     3 Discussion

     Closed digital artery injury usually caused by blunt injury caused by the skin integrity because of a finger and easily missed, so the correct

    means to judge whether the arterial injury and to determine the site of injury is to ensure that the key to survival of the fingers, when a clear history of trauma, injury site with ecchymosis, the injured area beyond

    finger skin temperature is low, the color pale or gray-purple, slow

    capillary reflux should be highly suspected arterial injuries; if there are fractures caused by shortening deformities can be observed after traction reduction, blood circulation not improve arterial injury should

    also be considered [2]. Emergency color Doppler ultrasound to detect possible to judge whether there is vascular injury. Authors believe that, once suspected that arterial injury, surgical exploration should be active as soon as possible, using vascular graft repair. The group of 28 cases by surgical exploration that are found in arterial injury and thrombosis, and almost all at the same time as the bilateral dorsal damage, direct anastomosis is not easy.

     Meanwhile, the closed artery injury often due to the venous system is still perfect, there is still the tip of finger blood, making it easy to judge errors, take a conservative treatment is often the loss of timing of surgery, which is caused by necrosis of the fingers causes. Giddin et al

    [3] have reported three cases of conservative treatment although 1 case of necrosis of the fingers are not, but the pulp after a low tension, chills, functional difference. Shao Jinlong et al [4] reported two cases of failing to repair artery Erzhi finger necrosis.

     The key is the operative paragraphs of vascular injury judgments. The normal lumen intima-free separation, the lumen without floating objects, wall elasticity good tourniquet release when the blood vessels Bo moving well, there are jet-like bleeding. Meanwhile, in the detection of blood vessels should be ligated carefully to each branch of the blood vessels will not tolerate the damage should be cut off, take the matching forearm superficial vein graft for repair of finger artery; vascular tone is

    moderate, not too tight incision suture. Require hand surgeon has a good micro-surgical techniques, surgical anastomosis artery, easy to vascular tone or injury due to incomplete removal of the vascular thrombosis

occurs, so that the low survival rate.

     References

     1 Kai Liu, Shuo-Gui Xu, Li Jie, et al. Fingers artery injury in 19 patients with diagnosis and treatment. Zhengzhou University (Medical Edition), 2006, (1): 188 ~ 189.

     2 SONG Hai-Tao, Tian Wan Cheng, Kang Qinglin, et al. Fingers closed

    injury crisis led to the treatment of arteries. Chinese Journal of Hand Surgery, 2001,17 (4): 255.

     3 Giddins GE. Burge Closed Vascular of finger. J Bone Joint Surg (Br), 1996,78:325 ~ 327.

     4 Shao Jinlong, the Soviet Union Red Army, Jin Weimin, et al. Artery

    caused by closed injury of fingers crisis of diagnosis and treatment. Practical Hand Surgery, 2002,16 (4): 233. Reposted elsewhere in the paper for free download http://www. hi138.com

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