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Arterial spasticity and cold intolerance in relation to time after digital replantation
C Backman1, A Nyström, C Backman
1Department of Hand Surgery, University Hospital of Northern Sweden, Umeå.
Insights
Digital replantation patients experience cold-induced arterial vasospasm, particularly within the first year post-surgery. This vasospasm persists, impacting cold tolerance, but may lessen over two years after digital replantation.
Area of Science:
- Vascular Surgery
- Microsurgery
- Trauma Surgery
Background:
- Digital replantation aims to restore function after traumatic amputation.
- Cold intolerance is a common complaint following digital injuries and surgery.
- Arterial vasospasm can compromise blood flow in replanted digits.
Purpose of the Study:
- To investigate cold-induced arterial vasospasm in patients undergoing single digit replantation.
- To assess the temporal changes in vasospasm and its relation to cold tolerance.
Main Methods:
- Studied ten patients with single digit replantation.
- Measured finger systolic pressure at varying finger temperatures.
- Evaluated patients at three time points: within 2 weeks, 1 year, and 3 years post-surgery.
Main Results:
- Cold-related vasospasm develops within the first year after digital replantation and appears persistent.
- Subjective cold tolerance is partly attributed to vasospasm, being less severe in patients without pathological vasospasm in the replanted digit.
- Cold intolerance shows a decreasing trend in the first two years post-replantation but does not fully resolve.
Conclusions:
- Cold-induced arterial vasospasm is a significant factor affecting cold tolerance in digital replantation patients.
- Vasospasm is established early and persists long-term, though its impact on cold intolerance may diminish over time.
- Replantation may mitigate, but not eliminate, cold intolerance associated with digital trauma.
Abstract:
Cold induced arterial vasospasm was studied in ten patients with single digit replantation, by measuring finger systolic pressure at different finger temperatures. Each patient was examined three times; within 2 weeks of surgery, after 1 year and after 3 years. The replantations were performed using long arterial and venous grafts. Cold-related vasospasm is established during the first year after trauma, and thereafter seems to be persistent. It is concluded that the subjective cold tolerance, which affects all patients after digital amputation regardless of whether replantation is performed or not, is partly due to vasospasm. It is less pronounced in patients without pathological vasospasm in the replanted digit. Cold intolerance is likely to decrease during the first 2 years after replantation, but not to disappear completely.