Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jian , HUANG Jian , PAN Jiadong , ZHOU Danya , YIN Shanqing , LI Junjie ,  WANG Xin

Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo Zhejiang, 315040, P.R.China;

Corresponding author：

WANG Xin, Email: dr.wangxin@hotmail.com

Keywords：

Thumb and finger reconstruction; free tissues transplantation; vascular crisis

DOI：

10.7507/1002-1892.201611030

Video：

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Objective To explore the causes of vascular crisis after thumb and other finger reconstruction by toe-to-hand transfer and effective treatment methods so as to improve the survival rate of transplanted tissues. Methods Between February 2012 and October 2015, 59 cases of thumb and other finger defects were repaired with different hallux nail flaps with the same vascular pedicle flap to reconstruct thumb and other fingers and repair skin defect. The donor site was repaired by a perforator flap. A total of 197 free tissues were involved. There were 46 males and 13 females with the average age of 30.6 years (range, 18-42 years). Vascular crisis occurred in 21 free tissues (10.7%) of 17 patients, including 9 arterial crisis (4.6%) of 8 cases, and 12 venous crisis (6.1%) of 10 cases. Conservative treatment was performed first; in 8 free tissues of 7 cases after failure of conservative treatment, anastomotic thrombosis was found in 5 free tissues of 4 cases, twisted vascular pedicle in 1 free tissue of 1 case, surrounding hematoma in 1 free tissue of 1 case, and anastomotic thrombosis associated with hematoma in 1 free tissue of 1 case, which underwent clearing hematoma, resecting embolization, regulating vascular tension, re-anastomosis or vascular transplantation. Results In 8 cases of arterial crisis, 5 free tissues of 5 cases survived after conservative treatment; partial necrosis occurred in 1 free tissue (1 case) of 4 free tissues (3 cases) undergoing surgical exploration. In 10 cases of venous crisis, 1 free tissue necrosis and 1 free tissue partial necrosis occurred in 8 free tissues (6 cases) undergoing conservative treatment; partial necrosis occurred in 1 free tissue of 4 free tissues (4 cases) undergoing surgical exploration. Free flap and skin graft were performed on 2 free tissues of 4 cases having flap necrosis respectively. Conclusion Vascular crisis is complex and harmful to survival of transplanted tissue in reconstruction of the thumb and other fingers. Immediate intervention is helpful to obtain a higher survival rate.

Citation： ZHANG Jian, HUANG Jian, PAN Jiadong, ZHOU Danya, YIN Shanqing, LI Junjie, WANG Xin. Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 323-326. doi: 10.7507/1002-1892.201611030 Copy

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3.	刘良燚, 张子清, 马立峰, 等. 双足第 2 趾移植再造多指缺损的临床经验. 中华手外科杂志, 2014, 30(4): 281-282.
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11.	章伟文, 陈宏, 李学渊, 等. 足趾移植手指再造术血管危象的防治. 中华手外科杂志, 2008, 24(2): 96-98.
12.	王扬剑, 李学渊, 王晓峰, 等. 术前多普勒超声定位 Freestyle 穿支蒂螺旋桨皮瓣修复下肢皮肤缺损效果观察. 现代实用医学, 2016, 28(10): 1274-1276.
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14.	范学凯, 潘佳栋, 夏华杰, 等. MDCTA 辅助设计的腓肠内侧动脉穿支皮瓣修复手腕部皮肤软组织缺损. 中华手外科杂志, 2015, 31(5): 365-368.
15.	侯春林, 顾玉东. 皮瓣外科学. 2版. 上海: 上海科学技术出版社, 2013: 211-212.
16.	傅尚俊, 杨晓东, 杨锦, 等. 游离股前外皮瓣移植术后静脉危象的病因探讨. 中华手外科杂志, 2015, 31(4): 313-314.
17.	杨建荣, 秦涛, 李宏卫. 游离皮瓣血管危象处理的实验研究. 口腔医学杂志, 2002, 22(4): 172-173.
18.	王剑利, 赵刚, 王五洲, 等. 游离皮瓣移植 1270 例回顾性研究. 中华显微外科杂志, 2012, 35(3): 189-193.

1. 刘刚义, 席志峰, 王从虎, 等. 多块游离组织组合移植修复重建手功能. 中华显微外科杂志, 2012, 35(4): 336-337.
2. 王文德, 李宗宝, 王业本, 等. 多手指缺失的显微外科再造. 中华显微外科杂志, 2005, 28(1): 19-20.
3. 刘良燚, 张子清, 马立峰, 等. 双足第 2 趾移植再造多指缺损的临床经验. 中华手外科杂志, 2014, 30(4): 281-282.
4. 芮永军, 许亚军, 张全荣, 等. 五块游离组织组合移植修复手脱套伤. 中华显微外科杂志, 2007, 30(4): 258-260.
5. 刘勇, 张成进, 付兴茂, 等. 严重手指伴手掌部分缺失的修复重建. 中华手外科杂志, 2015, 31(3): 212-214.
6. 韩明通, 何旭, 王博, 等. 应用皮瓣修复游离足趾移植后供区创面. 中华移植杂志(电子版), 2011, 5(1): 39-41.
7. 王欣, 潘佳栋, 黄耀鹏, 等. 两个或以上组织瓣游离移植再造拇手指并修复足部供区 59 例. 中华手外科杂志, 2016, 32(5): 321-324.
8. 顾玉东. 第二趾移植再造拇指的历史回顾与展望. 中华手外科杂志, 2006, 22(1): 3-5.
9. 卢宏, 李中锋, 李君, 等. 小血管吻合术后发生血管危象原因的分析及防治. 中国修复重建外科杂志, 1998, 12(5): 294-296.
10. 韩素琴, 黄耀鹏, 潘佳栋, 等. 保留供区足趾长度的拇指缺损再造术的围手术期护理. 中华显微外科杂志, 2016, 39(3): 305-306.
11. 章伟文, 陈宏, 李学渊, 等. 足趾移植手指再造术血管危象的防治. 中华手外科杂志, 2008, 24(2): 96-98.
12. 王扬剑, 李学渊, 王晓峰, 等. 术前多普勒超声定位 Freestyle 穿支蒂螺旋桨皮瓣修复下肢皮肤缺损效果观察. 现代实用医学, 2016, 28(10): 1274-1276.
13. 蔡晓明, 陈宏, 王欣, 等. CT 血管造影与彩色多普勒超声成像技术在足趾移植再造拇手指中的临床应用. 中华显微外科杂志, 2015, 38(3): 258-261.
14. 范学凯, 潘佳栋, 夏华杰, 等. MDCTA 辅助设计的腓肠内侧动脉穿支皮瓣修复手腕部皮肤软组织缺损. 中华手外科杂志, 2015, 31(5): 365-368.
15. 侯春林, 顾玉东. 皮瓣外科学. 2版. 上海: 上海科学技术出版社, 2013: 211-212.
16. 傅尚俊, 杨晓东, 杨锦, 等. 游离股前外皮瓣移植术后静脉危象的病因探讨. 中华手外科杂志, 2015, 31(4): 313-314.
17. 杨建荣, 秦涛, 李宏卫. 游离皮瓣血管危象处理的实验研究. 口腔医学杂志, 2002, 22(4): 172-173.
18. 王剑利, 赵刚, 王五洲, 等. 游离皮瓣移植 1270 例回顾性研究. 中华显微外科杂志, 2012, 35(3): 189-193.

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Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer

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