[Estimation of regional blood flow in reimplanted segments of upper extremity].
OBJECTIVE
To examine the state of regional circulation in replanted segment of upper limb and hand, to determine diagnostic and prognostic value of radionuclide scintigraphy.


METHODS
The study included 26 patients who underwent replantation of upper extremity segments. The control group included 12 patients who underwent autologous transplantation of toes on hand. All patients underwent isotope scintigraphy, ultrasound Doppler and pulse oximetry. Groups were comparable by gender, age, severity of injury.


RESULTS
Depending on postoperative course two groups were determined: with favorable (27 patients) and complicated postoperative period (11 patients). Two types of regional circulation were identified according to dynamic scintigraphy: prevalence of blood flow in operated limb (type 1); prevalence of blood flow in healthy limb, or equal volumetric blood flow in operated and healthy limbs (type 2). Favorable early postoperative period was associated with prevalence of blood flow in operated limb. Only in 2 (7.7%) patients patients in this group acute arterial thrombosis was diagnosed. At the same time thrombosis of microanastomosis occurred in 45.4% of cases in the second group what is 5.5 times higher than in the first group.


CONCLUSIONS
Significant prevalence of blood flow in operated limb is favorable prognostic sign of the early postoperative period. On the other hand the identity of blood flow or prevalence of such in healthy limb predispose to acute vascular complications in replantate or autoplantate. Radionuclide scintigraphy provides detailed assessment of regional blood flow in operated limb. However clinical monitoring has leading role in diagnosis of acute circulatory disorders in replantate or autoplantate.
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
K V
KV
Svetlov
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
E B
EB
Svirshchevskij
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
E I
EI
Trofimov
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
V V
VV
Filippov
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
S O
SO
Adrianov
Department of reconstructive and maxillofacial surgery and the laboratory of radioisotope diagnosis, acad. B.V. Petrovskiy Russian Research Center of Surgery FANO, Moscow, Russia.
T V
TV
Rodionova
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D064592:Autografts; D005260:Female; D005385:Fingers / Q000637:transplantation*; D006801:Humans; D008297:Male; D008833:Microcirculation; D012039:Regional Blood Flow / Q000502:physiology*; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D034941:Upper Extremity / Q000098:blood supply / Q000293:injuries / Q000601:surgery*; D014954:Wrist Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*