Köroğlu Muhammed, Karakaplan Mustafa, Zontul Sezgin, Acet Ömer, Özdeş Hüseyin Utku, Ergen Emre, Aslantürk Okan, Ertem Kadir, Yaşar Şeyma
İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi, Ortopedi ve Travmatoloji Anabilim Dalı, 44280 Malatya, Türkiye.
Jt Dis Relat Surg. 2025 Jan 2;36(1):65-77. doi: 10.52312/jdrs.2025.1900. Epub 2024 Oct 18.
In this study, we aimed to evaluate microvascular changes using nailfold capillaroscopy in patients who underwent digit replantation and revascularization.
A total of 46 patients (34 males, 12 females; mean age: 45.8±17.6 years; range, 18 to 75 years) who underwent replantation or revascularization procedures between February 2012 and May 2023 were retrospectively analyzed. Nailfold capillaroscopy images were assessed for various parameters including capillary count, diameter, dilatation, presence of giant capillaries, capillary disarrangement, microhemorrhages, neoangiogenesis, subpapillary plexus appearance, crossing capillaries, tortuosity, and microaneurysm. We investigated the association between microvascular alterations and clinical outcomes.
Of 46 patients, 25 patients underwent replantation and 21 patients underwent revascularization. Significant microvascular changes, including subpapillary venous plexus, microvascular enlargement, microhemorrhages, neoangiogenesis, and tortuosity were observed in replantation patients (p=0.000, p=0.020, p=0.021, p=0.001, and p=0.004, respectively). However, these changes were not significant in revascularization patients. Revascularization patients exhibited an increase in capillary diameter and disarrangement (p=0.019 and p=0.016, respectively). A significant negative correlation existed between digital nerve repairs and microvascular enlargement in replantation patients. Hyperesthesia was significantly correlated with neoangiogenesis and capillary disarrangement, while a statistically significant positive relationship was found between subpapillary venous plexus and patient satisfaction in replantation patients.
Our study showed that replantation patients who underwent two nerve repairs exhibited a well-regulated microvascular tone. However, we did not observe a statistically significant relationship between the number of nerve repairs and cold intolerance. Based on these findings, we highlight the potential of nailfold capillaroscopy in detecting microvascular changes following replantation and revascularization, which may contribute to a better understanding of the etiology of neurovascular complications.
在本研究中，我们旨在使用甲襞毛细血管镜评估接受断指再植和血管再通术患者的微血管变化。
回顾性分析了2012年2月至2023年5月期间接受再植或血管再通手术的46例患者（34例男性，12例女性；平均年龄：45.8±17.6岁；范围18至75岁）。对甲襞毛细血管镜图像进行了多种参数评估，包括毛细血管数量、直径、扩张、巨大毛细血管的存在、毛细血管排列紊乱、微出血、新生血管形成、乳头下静脉丛外观、交叉毛细血管、迂曲度和微动脉瘤。我们研究了微血管改变与临床结局之间的关联。
46例患者中，25例接受了再植手术，21例接受了血管再通手术。在再植患者中观察到显著的微血管变化，包括乳头下静脉丛、微血管扩张、微出血、新生血管形成和迂曲度（分别为p = 0.000、p = 0.020、p = 0.021、p = 0.001和p = 0.004）。然而，这些变化在血管再通患者中并不显著。血管再通患者的毛细血管直径增加且排列紊乱（分别为p = 0.019和p = 0.016）。在再植患者中，指神经修复与微血管扩张之间存在显著的负相关。感觉过敏与新生血管形成和毛细血管排列紊乱显著相关，而在再植患者中，乳头下静脉丛与患者满意度之间存在统计学上的显著正相关。
我们的研究表明，接受两次神经修复的再植患者微血管张力调节良好。然而，我们未观察到神经修复次数与冷不耐受之间存在统计学上的显著关系。基于这些发现，我们强调甲襞毛细血管镜在检测再植和血管再通术后微血管变化方面的潜力，这可能有助于更好地理解神经血管并发症的病因。
