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Correlation of volumetric flow rate and skin blood flow with cold intolerance in digital replantation.

Abstract Cold intolerance is a common complication of digital replantation. The exact etiology is unclear, but it is considered to be multifactorial, including nonsurgical characteristics, vascular, and neurologic conditions. Blood flow may play a significant role in cold intolerance. This study was designed to evaluate the correlation of digital blood flow, including volumetric flow rate (VFR) and skin blood flow (SkBF), with cold intolerance in replanted fingers.A retrospective study was conducted among patients who underwent digital replantation between 2010 and 2013. Patients were selected into study cohort based on the inclusion criteria. Surgical data was collected on each patient, including age, sex, injury mechanism, amputation level, ischemia time, number of arteries repaired, and whether or not vascular crisis occurred. Patients were included as study cohort with both nerves repaired and without chronic disease. Cold intolerance was defined as a Cold Intolerance Symptom Severity (CISS) score over 30. The arterial flow velocity and caliber were measured by Color Doppler Ultrasound and the digital VFR was calculated. The SkBF was measured by Laser Speckle Imager. Both VFR and SkBF were calculated as a percentage of the contralateral fingers. Comparative study of surgical data and blood flow was performed between the patient with and without cold intolerance. Correlation between VFR and SkBF was also analyzed.A total of 93 patients met inclusion criteria for the study. Approximately, 42 patients were identified as having cold intolerance. Fingers that survived vascular crisis had a higher incidence of cold intolerance with a lower VFR and SkBF. The VFR was higher in 2-artery replantation, but the SkBF and incidence of cold intolerance did not differ significantly. No differences were found in age, sex, injury mechanism, amputation level, or ischemia time. Furthermore, no correlation was found between VFR and SkBF.Cold intolerance of digital replantation is associated with decreased SkBF and VFR in the replanted fingers, which survived vascular crisis. Further work will be focused on how vascular crisis cause the decreasing of SkBF and VFR and the increasing chance of cold intolerance.
PMID
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Authors

Mayor MeshTerms

Replantation

Keywords
Journal Title medicine
Publication Year Start




PMID- 29390590
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 51
DP  - 2017 Dec
TI  - Correlation of volumetric flow rate and skin blood flow with cold intolerance in 
      digital replantation.
PG  - e9477
LID - 10.1097/MD.0000000000009477 [doi]
AB  - Cold intolerance is a common complication of digital replantation. The exact
      etiology is unclear, but it is considered to be multifactorial, including
      nonsurgical characteristics, vascular, and neurologic conditions. Blood flow may 
      play a significant role in cold intolerance. This study was designed to evaluate 
      the correlation of digital blood flow, including volumetric flow rate (VFR) and
      skin blood flow (SkBF), with cold intolerance in replanted fingers.A
      retrospective study was conducted among patients who underwent digital
      replantation between 2010 and 2013. Patients were selected into study cohort
      based on the inclusion criteria. Surgical data was collected on each patient,
      including age, sex, injury mechanism, amputation level, ischemia time, number of 
      arteries repaired, and whether or not vascular crisis occurred. Patients were
      included as study cohort with both nerves repaired and without chronic disease.
      Cold intolerance was defined as a Cold Intolerance Symptom Severity (CISS) score 
      over 30. The arterial flow velocity and caliber were measured by Color Doppler
      Ultrasound and the digital VFR was calculated. The SkBF was measured by Laser
      Speckle Imager. Both VFR and SkBF were calculated as a percentage of the
      contralateral fingers. Comparative study of surgical data and blood flow was
      performed between the patient with and without cold intolerance. Correlation
      between VFR and SkBF was also analyzed.A total of 93 patients met inclusion
      criteria for the study. Approximately, 42 patients were identified as having cold
      intolerance. Fingers that survived vascular crisis had a higher incidence of cold
      intolerance with a lower VFR and SkBF. The VFR was higher in 2-artery
      replantation, but the SkBF and incidence of cold intolerance did not differ
      significantly. No differences were found in age, sex, injury mechanism,
      amputation level, or ischemia time. Furthermore, no correlation was found between
      VFR and SkBF.Cold intolerance of digital replantation is associated with
      decreased SkBF and VFR in the replanted fingers, which survived vascular crisis. 
      Further work will be focused on how vascular crisis cause the decreasing of SkBF 
      and VFR and the increasing chance of cold intolerance.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Zhao, Gang
AU  - Zhao G
AD  - Department of Medicine, Soochow University, Suzhou.
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
FAU - Mi, Jingyi
AU  - Mi J
AD  - Department of Medicine, Soochow University, Suzhou.
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
FAU - Rui, Yongjun
AU  - Rui Y
AD  - Department of Medicine, Soochow University, Suzhou.
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
FAU - Pan, Xiaoyun
AU  - Pan X
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
FAU - Yao, Qun
AU  - Yao Q
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
FAU - Qiu, Yang
AU  - Qiu Y
AD  - Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Amputation, Traumatic/*surgery
MH  - Cold Temperature/*adverse effects
MH  - Female
MH  - Finger Injuries/*surgery
MH  - Fingers/blood supply
MH  - Humans
MH  - Male
MH  - Regional Blood Flow
MH  - *Replantation/adverse effects
MH  - Retrospective Studies
MH  - Skin/*blood supply
PMC - PMC5758292
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009477 [doi]
AID - 00005792-201712220-00177 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(51):e9477. doi: 10.1097/MD.0000000000009477.