Clinical evaluation and temperature monitoring in predicting viability in replantations

Experiences with temperature and clinical monitoring in a series of 111 patients with 188 revascularized digits were reviewed. Criteria for abnormal temperature monitoring were defined. Monitoring of only clinical parameters showed a sensitivity of 1.00 and specificity of .97, but this technique was time-consuming and required experienced interpretation of subtle clinical changes. Temperature monitoring gave a sensitivity of 1.00, while the specificity was only .61. Drops in temperature were frequently not associated with vascular problems. Review of digits with abnormal clinical or temperature monitoring showed five patterns of abnormality. The first three groups had either abnormal clinical or temperature monitoring, but all fingers survived without reexploration. The fourth and fifth groups showed abnormalities in both clinical and temperature monitoring; all but one finger were found to be nonviable. Combined clinical and temperature monitoring was highly effective in early prediction of vascular compromise, with a sensitivity of 1.00 and a specificity of .99. The authors recommend the use of temperature monitoring. If a temperature drop occurs, monitoring of the clinical parameters can then be done. If both temperature and clinical monitoring yield abnormal results after a specified time, intervention should be carried out.