Toshinskiy Sergey, Frees Michelle, Hillard Christopher
University of Minnesota School of Medicine, Minneapolis, MN, United States.
Department of Plastic Surgery, Regions Hospital, St Paul, MN, United States.
J Hand Microsurg. 2024 May 28;16(4):100080. doi: 10.1016/j.jham.2024.100080. eCollection 2024 Oct.
Venous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place. The aim of this study is to evaluate the efficacy of leech therapy in the revascularized and replanted digits and determine risk factors for unsuccessful salvage.
A retrospective review was performed to identify all patients with complete or incomplete digital amputations at an academic Level 1 Trauma Center who underwent digital replantation or revascularization from January 2005 to December 2020. Amputations proximal to the palmar arch as well as revascularizations that showed any degree of perfusion on preoperative assessment were excluded. Leech therapy was initiated as soon as any signs of venous congestion appeared and was titrated to clinical effect. Patient demographics, medical history, injury mechanism, extent and level, operative details, leech therapy details, number of blood transfusions, hospitalization length, as well as the digit's ultimate survival data were collected.
Of the 159 patients who underwent 213 digital revascularizations (n = 135) and replantations (n = 78), venous congestion requiring leech therapy developed in 27 digits in the revascularization group and in 26 in the replantation group. Of the digits that were leeched, 15 failed in the revascularization group (56 % failure rate) and 17 failed in the replantation group (65 % failure rate). Avulsion mechanism of injury and presence of a circumferential laceration were significantly associated with rate of failure in the revascularization cohort (p < 0.01). Proximal level of injury was significantly associated with rate of failure in the replantation group (p < 0.01).
Leech therapy has limited efficacy in avulsed or more proximally injured digits. These data can aid in determining the prognosis of a digit with venous congestion after revascularization and replantation.
静脉淤血是手指再植和血管重建术后的常见现象。水蛭疗法可在血管生成和新生血管形成时促进静脉流出。本研究的目的是评估水蛭疗法在再植和血管重建手指中的疗效，并确定挽救失败的危险因素。
进行回顾性研究，以确定2005年1月至2020年12月期间在一级学术创伤中心接受手指再植或血管重建的所有完全或不完全断指患者。手掌弓近端的截肢以及术前评估显示有任何程度灌注的血管重建均被排除。一旦出现静脉淤血迹象，立即开始水蛭疗法，并根据临床效果进行调整。收集患者的人口统计学资料、病史、损伤机制、范围和水平、手术细节、水蛭疗法细节、输血次数、住院时间以及手指的最终存活数据。
在159例接受213次手指血管重建（n = 135）和再植（n = 78）的患者中，血管重建组有27个手指出现需要水蛭疗法的静脉淤血，再植组有26个手指出现。在接受水蛭疗法的手指中，血管重建组有15个失败（失败率56%），再植组有17个失败（失败率65%）。撕脱伤机制和环形撕裂的存在与血管重建队列中的失败率显著相关（p < 0.01）。损伤的近端水平与再植组的失败率显著相关（p < 0.01）。
水蛭疗法在撕脱伤或近端损伤更严重的手指中疗效有限。这些数据有助于确定血管重建和再植术后出现静脉淤血手指的预后。
