Lu Wei, Wang Daping, Liu Lijun, Xiong Jianyi, He Qianwen
Department of Traumatic and Hand Surgery, Southern Medical University Shenzhen Hospital, Shenzhen, Guangdong, China.
Microsurgery. 2008;28(1):13-6. doi: 10.1002/micr.20445.
Observation of circulation in replanted severed fingers often relies on the clinical experience of the doctor. This article discusses nail fold capillary loops (NFCL) observation in the monitoring of the perfusion and circumfluence of replanted digits. In our study, 30 patients with a total of 39 replanted digits were selected. The WX-9A900 Microcirculation Checkout System (MCS) was adopted to perform evaluation of circulation postoperatively. The digits were monitored by clinical examination and MCS at 5- to 7-h intervals for 24 h and then at 2-days intervals for 14 days. Our results showed that seven digits were observed with inadequate venous circumfluence, and large, long NFCL presented within 6-12 h postoperatively. Among the replanted digits, two replants resulted in venous crisis that did respond to an arterial interdiction test, and needed venous grafts. Two digits were observed to have insufficient arterial supply, one of which resulted in arterial crisis. In this case, NFCL could not be observed and had no response to vein interdiction test. This case needed venous graft to rebuild blood perfusion, and survived eventually. We concluded therefore, that compared with the former studies, NFCL correlates closely with the perfusion and circumfluence of the replanted digits. MCS is noninvasive, reliable, and a direct method in postoperative monitoring of digit replanted.
断指再植后血液循环的观察往往依赖于医生的临床经验。本文探讨甲襞毛细血管袢（NFCL）观察在断指再植灌注及回流监测中的应用。在我们的研究中，选取了30例患者共39根断指再植病例。采用WX - 9A900微循环检测仪（MCS）对再植术后的血液循环进行评估。术后24小时内每隔5至7小时通过临床检查和MCS对断指进行监测，之后14天内每隔2天监测一次。我们的结果显示，观察到7根断指静脉回流不足，术后6至12小时出现大而长的NFCL。在再植的断指中，有2例再植出现静脉危象，对动脉阻断试验有反应，需要进行静脉移植。观察到2根断指动脉供血不足，其中1根导致动脉危象。在此病例中，未观察到NFCL，对静脉阻断试验无反应。该病例需要进行静脉移植以重建血液灌注，最终存活。因此，我们得出结论，与以往研究相比，NFCL与断指再植的灌注及回流密切相关。MCS是一种无创、可靠且直接的断指再植术后监测方法。
