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Delayed toe transplantation: experimental study and clinical application
1Department of Hand Surgery at Huashan Hospital, Shanghai Medical University, People's Republic of China. ilao@public4.sta.net.cn
Insights
Delayed toe transplantation, performed 17-21 hours after dissection due to circulatory crisis, achieved 100% survival. This method, involving delayed pedicle division, effectively manages vascular variations and crises in toe transfers.
Area of Science:
- Microsurgery
- Vascular Surgery
- Transplantation Biology
Background:
- Toe transplantation is a complex procedure often complicated by circulatory crisis.
- Vascular variations can impede immediate toe transfer.
- Successful outcomes in challenging cases require innovative surgical timing.
Purpose of the Study:
- To evaluate the efficacy of delayed toe transplantation in cases of circulatory crisis.
- To investigate the underlying physiological mechanisms of delayed toe transfer.
- To determine the optimal timing for pedicle division and toe transfer.
Main Methods:
- Ten clinical cases of toe transplantation with delayed transfer (17-21 hours post-dissection) due to circulatory crisis were analyzed.
- Animal experiments in 36 rabbits involved hind limb severance, preserving the vascular pedicle.
- Endothelin and nitric oxide levels in local tissues and arterial walls were measured at various postoperative intervals (4, 8, 16, 24, 48 hours).
Main Results:
- All 10 clinical cases of delayed toe transplantation resulted in 100% graft survival.
- In rabbit models, a significant increase in endothelin and decrease in nitric oxide were observed 4-8 hours post-operation.
- By 16-24 hours post-operation, endothelin levels normalized, and nitric oxide levels significantly increased.
Conclusions:
- Delayed pedicle division and toe transfer is a highly effective strategy for toe transplantation, particularly in the presence of vascular variations and circulatory crisis.
- The mechanism of success is linked to dynamic changes in local tissue and arterial wall endothelin and nitric oxide levels.
- This approach offers a viable solution for improving outcomes in challenging toe transplant scenarios.
Abstract:
Delay of the operation in toe transplantation was performed with circulatory crisis, and 100 percent survival of the transplants was achieved. In 10 cases of toe transplantation in which circulatory crisis occurred, the operation was delayed. The vascular pedicle was divided, and the toe was transferred 17 to 21 hours after the donor toe was dissected. To investigate the mechanism of delayed toe transplantation, experiments in rabbits were carried out. In 36 rabbits, the hind limbs were severed except for the vascular pedicle. The endothelin content and nitric oxide content of the tissues in the hind limb and the arterial wall were tested in postoperative intervals of 4, 8, 16, 24, and 48 hours, respectively. The results showed that in 10 cases of delayed toe transplantation, all toes survived. As for the results of the experiment, there was significant increase of endothelin content and decrease of nitric oxide content in the local tissues and the arterial wall 4 to 8 hours after the operation. In postoperative 16 to 24 hours, endothelin content returned to normal level, and nitric oxide content increased remarkably. It is concluded that delayed pedicle division and toe transfer is an effective method in toe transplantation with vascular variations and circulatory crisis. The mechanism is related to the endothelin and nitric oxide content in the local tissue and the arterial wall. The indications for delayed toe transfer are also discussed.