Investigation of Metabolism and Perfusion in Arterialized Venous Replantation

Abstract

Replantation of amputated digits at distal levels is difficult because the vessels are either too small or absent in the amputated part. Clinically unconventional anastomoses have been tried in such instances. Arterialization of the venous system in the amputated part was also utilized for this purpose. In this study, a digital replantation model utilizing the amputated rabbit ear was used to evaluate the survival, metabolism, and perfusion of unconventionally replanted parts. Mean survival areas were measured and perfusion studies with technetium 99m, blood gases, pH, blood glucose and lactate levels, tissue glucose and lactate levels, and histological evaluations were performed. Surviving areas did not reveal a significant difference. Perfusion of the arterialized venous replants were not as good as the conventionally replanted ears. The blood glucose and lactate levels in the afferent vein were initially near normal arterial levels but almost reached normal venous levels in the samples taken 24 hours after the arterialized venous replantation. Tissue glucose levels were lower than the conventionally perfused tissue, and the lactate levels were higher, but these two metabolite levels were normalized in later samples. The results of the metabolic and perfusion studies are interpreted to elucidate the survival mechanisms in the arterialized venous replants. As a result, arterialized venous replantation may be supported by the favorable results of metabolic and perfusion studies in our experimental model.