TY - JOUR
T1 - Arterial reconstruction in the ischemic hand and wrist
T2 - Effects on microvascular physiology and health-related quality of life
AU - Koman, L. A.
AU - Ruch, D. S.
AU - Aldridge, M.
AU - Smith, B. P.
AU - Holden, M. B.
AU - Fulcher, M.
N1 - Funding Information:
The surgical management of occlusive and/or vaso-occlusive disease of the distal upper extremity is based primarily on empiric observation and experience. Historically, treatment of chronic digital isch- From the Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Disease (National Institutes of Health Grant No. AR41765). Received for publication November 14, 1997; accepted in revised form March 24, 1998. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Presented in part at the 50th annual meeting of American Society for Surgery of the Hand, San Francisco, CA, September 1995. Reprint requests: L. Andrew Koman, MD, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1070. Copyright 9 1998 by the American Society for Surgery of the Hand 0363-5023/98/23A05-001053.00/0 emia following thrombosis or embolus is attempted either to increase collateral flow by decreasing vasospasm (eg, pharmacologic interventions, biofeedback) or to re-establish flow by performing vascular operative procedures. 1-3 This report evaluates the hypothesis that surgical reconstruction of proximal occlusive disease in symptomatic patients with both wrist/palm level and digital level occlusive disease is associated with improvements in both health-related quality of life and digital microcirculation distal to the unreconstructed arterial segment. This study was designed to evaluate patients with vaso-occlusive disease of the hand and wrist before and after surgical intervention (1) to define the physiologic events in the digital microvasculature of the hand associated with chronic subcritical ischemia, (2) to demonstrate the short-term (2-6 months) effects of successful reconstruction on the thermoregulatory and nutritional components of microvascular flow, and (3) to
PY - 1998
Y1 - 1998
N2 - 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.
AB - 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.
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U2 - 10.1016/S0363-5023(98)80150-0
DO - 10.1016/S0363-5023(98)80150-0
M3 - Article
C2 - 9763249
AN - SCOPUS:0032461163
SN - 0363-5023
VL - 23
SP - 773
EP - 782
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 5
ER -