Deutinger M, Porenta G, Metz V, Kaliman J, Freilinger G
Abteilung für Plastische und Wiederherstellungschirurgie, Chirurgischen Universitätsklinik, Wien.
Handchir Mikrochir Plast Chir. 1989 Nov;21(6):283-6.
Forearm arterial injury usually does not lead to acute ischemia, but a functional deficit may develop. We tried to evaluate the need for two patent forearm arteries using rheological, Doppler sonographical and clinical parameters. Twenty-seven patients were examined after arterial and/or nerve injury in the forearm as well as six patients in whom a forearm flap was harvested. In seventeen patients both arteries were patent after primary reconstruction. Nine patients showed only one patent artery, while in the six patients with a forearm flap the radial artery was reconstructed in only one case. We found a decreased skin temperature in cases with artery and nerve injury. If both structures were reconstructed, the difference was not significant. The pressure of the finger collateral arteries and of the forearm arteries as well as the rheological investigation did not show any difference. The two-point discrimination, reflecting the nerve regeneration, was not affected, if one or two arteries had been reconstructed. Pain following exercise rarely occurred if both arteries of the forearm were patent. Because of the positive effect on skin temperature and of the reduced pain following exercise, reconstruction of both forearm arteries should be considered. Furthermore, the possibility of a subsequent arterial injury has to be taken into account.
前臂动脉损伤通常不会导致急性缺血,但可能会出现功能缺陷。我们试图利用流变学、多普勒超声和临床参数评估保留两条前臂动脉通畅的必要性。对27例前臂动脉和/或神经损伤患者以及6例切取前臂皮瓣的患者进行了检查。17例患者在一期重建后两条动脉均通畅。9例患者仅一条动脉通畅,而在6例切取前臂皮瓣的患者中,仅1例重建了桡动脉。我们发现动脉和神经损伤的病例皮肤温度降低。如果两者都进行了重建,差异不显著。手指侧支动脉和前臂动脉的压力以及流变学研究均未显示出任何差异。反映神经再生的两点辨别觉在重建一条或两条动脉后未受影响。如果前臂的两条动脉均通畅,运动后很少出现疼痛。鉴于对皮肤温度有积极影响且运动后疼痛减轻,应考虑重建两条前臂动脉。此外,必须考虑后续发生动脉损伤的可能性。