The experience of exploration of vascular crisis after 55 cases of vascular anastomosis

Abstract

Objective To comduct clinical analysis of 55 cases (63 incidents) of vascular crisis after vascular anastomosis.Methods Fifty-five cases (63 incidents) of vascular crisis treated in the Department of Hand Surgery in our hospital from April 2004 to December 2007 with complete data were retrospectively reviewed.There were 29 cases of finger replantation,17 cases of toe-to-finger transfer,8 cases of free flaps,and 1 case of incomplete finger amputation.All the cases of vascular crisis underwent surgical exploration after one hour conservative treatment failed to relieve the crisis.Intraoperative findings revealed the following vascular conditions:26 cases (30 incidents) of arterial embolization,17 cases (20 incidents) of artery spasm,10 cases (11 incidents) of vein thrombosis,2 cases (2 incidents) of vascular compression,1 case of too low arterial tension,1 cases of too high venous tension,and 1 case of arterial branches not being ligated.According to the intraoperative findings,forearm superficial vein grafting was done in 20 cases (23 incidents),resection of the embolized segment and vascular re-anastomosis was done in 33 cases (38 incidents),while removal of the tissue that compressed the vessel was done in one cases and local hematoma removal was carried out in another case.Results Among the 55 cases,51 cases survived.The survival rate was 92.73％.Tissue necrosis and subsequent failure occurred in 2 cases of finger replantation,1 case of toe-to-finger transfer,and 1 case of free flap.Conclusion In the event of vascular crisis after vascular anastomosis,once the conservative treatment proved ineffective,early and active surgical exploration was crucial for salvage and survival. Key words: Tissue transplantation; Microsurgery; Second-look surgery; Vascular crisis