Microvascular management of ring avulsion injuries

Urbaniak, James R.; Evans, John; Bright, Donald S.

doi:10.1016/s0363-5023(81)80006-8

Cited by 193 publications

(130 citation statements)

References 10 publications

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“…It is for this reason, that Sivelestat has found use in acute systemic respiratory distress syndrome and in the treatment of shock. [22,23] The release of elastase during postischemic reperfusion may be an important mechanism by which neutrophils cause tissue injury. We have shown in this study that Sivelestat treated groups, present with less inflammation.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

et al. 2018

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A vulsion and degloving injuries are caused by a vast array of mechanisms, machines and situations, in which the hand is injured with low energy shearing forces in a rigid position.[1] These types of injuries have generally been viewed as among the most problematic of injuries to manage due to their extensive nature of associated damage. During degloving injuries, blood vessels having great elasticity, are disembodied and separated with irreversible injury along the entire length of involvement and so are the tendons and nerves. Furthermore in circumferential degloving injuries, the distal flap goes through a state of abrupt ischemia followed by reverse perfusion forming after the reattachment of the flaps back to its' origin. Arnez et al, recently reclassified degloving injuries according to the Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. The purpose of this study is to acknowledge if Sivelestat, known to ameliorate ischemia reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat's effects to Pentoxifylline. Methods: Total flap area (cm 2 ), area of necrosis in the flap (cm 2 ), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups were documented with CD31, anti-PECAM stainings. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis. Results: This study demonstrated that, Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia reperfusion injury more pertinently than Pentoxifylline which exerts only hemorheological effects. Conclusion:The anti-inflammatory effects of Sivelestat, will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline which exerts only hemorheological effects.

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Section: Discussionmentioning

confidence: 99%

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

et al. 2018

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“…Hospital records and radiographs were reviewed to define the pattern of avulsion, classify the injury using the Urbaniak system, 6 and determine the size and configuration of each flap. Outcome analysis included flap survival, survival of the digit, as well as average total active range of motion (TAM) as described by Kleinert.…”

Section: Methodsmentioning

confidence: 99%

Use of the venous flap for salvage of difficult ring avulsion injuries

2008

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Ring avulsion can lead to soft tissue compromise resulting in eventual digit failure or restriction of motion. The authors present use of the venous flow through flap for simultaneous soft tissue and digital vessel reconstruction in severe ring avulsion injury. A retrospective review of ring avulsion injuries treated with transplantation of an arterialized (A-V-A) venous flap between 1999 and 2006 was conducted. Indications included digits which were debrided and required soft tissue and digital artery reconstruction. Eight venous flaps were transplanted for 3 Urbaniak class II and 5 Urbaniak class III ring avulsions. Average size of the venous flap was 6 cm(2). All flaps and digits survived without partial necrosis. The soft tissue envelope was supple in all cases. Total active motion (TAM) ranged from 160 to 210 degrees. The arterialized venous flow-through flap is a reliable solution for the complex ring avulsion injury which requires simultaneous soft tissue and digital vessel reconstruction.

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“…The mechanism of amputation was a blunt crushing injury which in some cases caused partial destruction and loss of tissue for a distance of a few millimeters. The vascular damage in these cases was found to be less serious than in roping injury [5], traction injury [2] and ring avulsion injury [3,8] in which the vessels are severely damaged by traction.…”

Section: Condition Of the Wound And Clinical Coursementioning

confidence: 99%

Replantation of the digits amputated by motorcycle chain injury

et al. 1991

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Summary. Over the past 5 years, 134 digits were replanted in 85 patients. In 9 patients -10 digits (11%) -the causation of injury was a motorcycle chain. The significant incidence of this type of injury has prompted us to report the replantation results. Hopefully, this might be used to caution the public against cleaning the chain while it is in motion. The sites of amputation were 5 in Tamai's Zone I and 5 in Tamai's Zone II. All amputated parts were distal to the DIP joint. The digits were replanted with anastomosis of both the artery and the vein. Eight out of the 10 replanted digits survived to give a success rate of 80%. There was no statistical difference between this rate and that for all other replanted digits resulting from various causes in Zones I and II, i.e, 86%. The high success rate suggests that replantation of the chain-amputated digits should be recommended, and the apparently poor conditions of the crush injury are no contraindications for surgery.

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Microvascular management of ring avulsion injuries

Cited by 193 publications

References 10 publications

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

Use of the venous flap for salvage of difficult ring avulsion injuries

Replantation of the digits amputated by motorcycle chain injury

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