ABSTRACT
The hydrogen washout technique was applied to an experimental model of microvascular repair to evaluate its potential use in determining blood flow after microvascular surgery. Three blood flow measurements were obtained in each of 10 rat hindlimbs with the hydrogen washout technique: a control, a reading with arterial flow disrupted, and a final reading after standard microvascular repair of only the saphenous artery. After repair, flow rate was 0.115 ml/minute/ml compared to 0.008 ml/minute/ml for the disrupted reading (p less than .01). The practical clinical applicability of the hydrogen washout technique for evaluating blood flow in the fingertip was tested on five human volunteers. Ischemia in the upper extremity was produced with a pneumatic tourniquet. The hydrogen washout technique and the Doppler pulse monitor were used simultaneously to evaluate circulation in the small finger. Hydrogen uptake occurred simultaneously with return of clinical signs of tissue perfusion during gradual tourniquet deflation. The Doppler pulse returned while clinical signs of ischemia remained. The use of hydrogen washout in monitoring three patients following microvascular surgery has shown it to be accurate in predicting survival. It has, thus far, proven itself to be easily repeatable and reliable both intraoperatively and postoperatively.
Subject(s)
Hydrogen , Replantation , Vascular Surgical Procedures , Adult , Animals , Female , Finger Injuries/surgery , Fingers/blood supply , Hindlimb/blood supply , Humans , Intraoperative Care , Male , Microsurgery , Middle Aged , Monitoring, Physiologic , Postoperative Care , Rats , Rats, Inbred Strains , Regional Blood FlowABSTRACT
The performance of 50 consecutive digits in 37 patients was analyzed following flexor tendon repair in Zone II. Twenty-five digits were managed by 3 1/2 weeks of immobilization followed by a program of gradually increased motion; 25 other digits by intermittent passive motion initiated within the first 5 days with active flexion commenced at 4 1/2 weeks. Results were graded according to the percentage of return of motion at the proximal and distal interphalangeal joints. There were four ruptures in the immobilization group with no excellent results, 12% being rated good, 28% fair, and 11% poor. In the digits managed by early mobilization there were 36% excellent, 20% good, 16% fair, 24% poor; there was one rupture in this group. Early passive motion appeared to be an effective technique to improve the results of flexor tendon repairs in this area.
Subject(s)
Exercise Therapy , Finger Injuries/surgery , Finger Joint/physiology , Immobilization , Tendon Injuries/surgery , Adult , Exercise Therapy/adverse effects , Humans , Postoperative Care/methods , RuptureABSTRACT
Orthopedic injuries in 25 pedestrian victims of automobile accidents were reviewed using severe craniocerebral trauma as the common denominator, A triad of craniocerebral injury, pelvic fracture and lower extremity injury was identified. Upper extremity injuries were uncommon and usually occurred in the shoulder girdle area. A delay in diagnosis of musculoskeletal injuries occurred in five patients (20%). Nineteen patients sustained fractures involving the lower extremity and/or pelvis (76%). The pedestrian victims had approximately a 50% occurrence of lower extremity injuries (14 of 25) and approximately 50% incidence of pelvic fractures (11 of 25). Six victims (24%) sustained both injuries. Routine roentgenography of the comatose pedestrian victim should include AP and lateral of the skull and cervical spine and AP of the chest, pelvis and knees.
