We analyzed 122 cases of replantation following complete amputation of the thumb and correlated various factors with rates of survival. The overall survival rate of thumb replantation was 71%. The type of amputation markedly affected survival rate. In minimally damaged amputations, the time period from injury to the start of surgery was the only significant factor related to survival. Other factors such as age, smoking history, amputation level, the number of vessels reconstructed and the method used did not relate statistically to survival. With avulsion amputations, the survival rate of replantation at and proximal to the MP joint was significantly better than replantation distal to the MP joint. 20 thumbs required re-exploration for vascular compromise; nine of these were salvaged (45%).
The purpose of this study was to compare the microcirculation perfusion and plasma-protein extravasation in varieties of venous nerve grafts. Venous nerve grafts were created from the left median nerve and brachial vein of the rabbit. The vein was interposed between (a) brachial artery to brachial artery (AVA); or (b) brachial artery to proximal cephalic vein (AVV); or (c) brachial vein to brachial vein (VVV). A standard, vascularized, nerve graft was created in the opposite limb, to serve as a control, and the untouched sciatic nerve served as a second control. Microcirculation perfusion and permeability of endoneurial vessels were evaluated using intravenously-injected albumin labelled with Evans blue dye (EBA) as a fluorescent tracer within 1 hr after surgery. Six hours after surgery, the nerves were removed and evaluated for tracer content and distribution. Extravasation of EBA was extensive in both AVA and AVV forms of the venous nerve graft, suggesting good perfusion but showing significant protein leakage and edema. VVV, on the other hand, had only slight extravasation, comparable to untouched sciatic nerves. Although the number of vessels filled with blood in the VVV was 69 percent of the vascularized nerve graft, the lack of marked extravasation may make it the venous nerve graft of choice.
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