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.	劉良燚, 張子清, 馬立峰, 等. 雙足第 2 趾移植再造多指缺損的臨床經驗. 中華手外科雜志, 2014, 30(4): 281-282.
4.	芮永軍, 許亞軍, 張全榮, 等. 五塊游離組織組合移植修復手脫套傷. 中華顯微外科雜志, 2007, 30(4): 258-260.
5.	劉勇, 張成進, 付興茂, 等. 嚴重手指伴手掌部分缺失的修復重建. 中華手外科雜志, 2015, 31(3): 212-214.
6.	韓明通, 何旭, 王博, 等. 應用皮瓣修復游離足趾移植后供區創面. 中華移植雜志(電子版), 2011, 5(1): 39-41.
7.	王欣, 潘佳棟, 黃耀鵬, 等. 兩個或以上組織瓣游離移植再造拇手指并修復足部供區 59 例. 中華手外科雜志, 2016, 32(5): 321-324.
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9.	盧宏, 李中鋒, 李君, 等. 小血管吻合術后發生血管危象原因的分析及防治. 中國修復重建外科雜志, 1998, 12(5): 294-296.
10.	韓素琴, 黃耀鵬, 潘佳棟, 等. 保留供區足趾長度的拇指缺損再造術的圍手術期護理. 中華顯微外科雜志, 2016, 39(3): 305-306.
11.	章偉文, 陳宏, 李學淵, 等. 足趾移植手指再造術血管危象的防治. 中華手外科雜志, 2008, 24(2): 96-98.
12.	王揚劍, 李學淵, 王曉峰, 等. 術前多普勒超聲定位 Freestyle 穿支蒂螺旋槳皮瓣修復下肢皮膚缺損效果觀察. 現代實用醫學, 2016, 28(10): 1274-1276.
13.	蔡曉明, 陳宏, 王欣, 等. CT 血管造影與彩色多普勒超聲成像技術在足趾移植再造拇手指中的臨床應用. 中華顯微外科雜志, 2015, 38(3): 258-261.
14.	范學凱, 潘佳棟, 夏華杰, 等. MDCTA 輔助設計的腓腸內側動脈穿支皮瓣修復手腕部皮膚軟組織缺損. 中華手外科雜志, 2015, 31(5): 365-368.
15.	侯春林, 顧玉東. 皮瓣外科學. 2版. 上海: 上海科學技術出版社, 2013: 211-212.
16.	傅尚俊, 楊曉東, 楊錦, 等. 游離股前外皮瓣移植術后靜脈危象的病因探討. 中華手外科雜志, 2015, 31(4): 313-314.
17.	楊建榮, 秦濤, 李宏衛. 游離皮瓣血管危象處理的實驗研究. 口腔醫學雜志, 2002, 22(4): 172-173.
18.	王劍利, 趙剛, 王五洲, 等. 游離皮瓣移植 1270 例回顧性研究. 中華顯微外科雜志, 2012, 35(3): 189-193.

1. ?劉剛義, 席志峰, 王從虎, 等. 多塊游離組織組合移植修復重建手功能. 中華顯微外科雜志, 2012, 35(4): 336-337.
2. 王文德, 李宗寶, 王業本, 等. 多手指缺失的顯微外科再造. 中華顯微外科雜志, 2005, 28(1): 19-20.
3. 劉良燚, 張子清, 馬立峰, 等. 雙足第 2 趾移植再造多指缺損的臨床經驗. 中華手外科雜志, 2014, 30(4): 281-282.
4. 芮永軍, 許亞軍, 張全榮, 等. 五塊游離組織組合移植修復手脫套傷. 中華顯微外科雜志, 2007, 30(4): 258-260.
5. 劉勇, 張成進, 付興茂, 等. 嚴重手指伴手掌部分缺失的修復重建. 中華手外科雜志, 2015, 31(3): 212-214.
6. 韓明通, 何旭, 王博, 等. 應用皮瓣修復游離足趾移植后供區創面. 中華移植雜志(電子版), 2011, 5(1): 39-41.
7. 王欣, 潘佳棟, 黃耀鵬, 等. 兩個或以上組織瓣游離移植再造拇手指并修復足部供區 59 例. 中華手外科雜志, 2016, 32(5): 321-324.
8. 顧玉東. 第二趾移植再造拇指的歷史回顧與展望. 中華手外科雜志, 2006, 22(1): 3-5.
9. 盧宏, 李中鋒, 李君, 等. 小血管吻合術后發生血管危象原因的分析及防治. 中國修復重建外科雜志, 1998, 12(5): 294-296.
10. 韓素琴, 黃耀鵬, 潘佳棟, 等. 保留供區足趾長度的拇指缺損再造術的圍手術期護理. 中華顯微外科雜志, 2016, 39(3): 305-306.
11. 章偉文, 陳宏, 李學淵, 等. 足趾移植手指再造術血管危象的防治. 中華手外科雜志, 2008, 24(2): 96-98.
12. 王揚劍, 李學淵, 王曉峰, 等. 術前多普勒超聲定位 Freestyle 穿支蒂螺旋槳皮瓣修復下肢皮膚缺損效果觀察. 現代實用醫學, 2016, 28(10): 1274-1276.
13. 蔡曉明, 陳宏, 王欣, 等. CT 血管造影與彩色多普勒超聲成像技術在足趾移植再造拇手指中的臨床應用. 中華顯微外科雜志, 2015, 38(3): 258-261.
14. 范學凱, 潘佳棟, 夏華杰, 等. MDCTA 輔助設計的腓腸內側動脈穿支皮瓣修復手腕部皮膚軟組織缺損. 中華手外科雜志, 2015, 31(5): 365-368.
15. 侯春林, 顧玉東. 皮瓣外科學. 2版. 上海: 上海科學技術出版社, 2013: 211-212.
16. 傅尚俊, 楊曉東, 楊錦, 等. 游離股前外皮瓣移植術后靜脈危象的病因探討. 中華手外科雜志, 2015, 31(4): 313-314.
17. 楊建榮, 秦濤, 李宏衛. 游離皮瓣血管危象處理的實驗研究. 口腔醫學雜志, 2002, 22(4): 172-173.
18. 王劍利, 趙剛, 王五洲, 等. 游離皮瓣移植 1270 例回顧性研究. 中華顯微外科雜志, 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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