Arterial reconstruction in the ischemic hand and wrist: effects on microvascular physiology and health-related quality of life.
Patients were evaluated before and after arterial reconstruction surgery (1) to define the physiology of the digital microcirculation in chronic subcritical ischemia, (2) to demonstrate the short-term effects of successful arterial reconstruction on microvascular flow, and (3) to document the effects of surgery on symptoms, function, and health-related quality of life. Arterial insufficiency was the result of a proximal reconstructible occlusive lesion, 1 or more distal unreconstructible occlusions, and secondary reactive vasospasm. Microvascular physiology was evaluated by monitoring digital temperatures, microvascular perfusion (laser Doppler fluxmetry) and perfusion patterns (laser Doppler perfusion patterns (laser Doppler perfusion imaging). Following successful vascular reconstruction, digital temperatures and microvascular perfusion improved significantly, approaching control levels. Although cold sensitivity was unchanged, symptoms decreased and upper extremity function and health-related quality of life improved after successful proximal reconstruction in patients with 2-level arterial occlusion.
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA.
L A
LA
Koman
D S
DS
Ruch
M
M
Aldridge
B P
BP
Smith
M B
MB
Holden
M
M
Fulcher
D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005385:Fingers / Q000098:blood supply*; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011788:Quality of Life; D017534:Radial Artery / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000473:pathology / Q000601:surgery; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods; D014953:Wrist / Q000098:blood supply*