Email this article Complications after toe-to-hand transfers in children with pathologies of the hand
- Authors: Golyana S.I.1, Tikhonenko T.I.1, Govorov A.V.1, Zaytseva N.V.1, Balashov A.V.2
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Affiliations:
- The Turner Scientific Research Institute for Children’s Orthopedics
- Children’s City Hospital No 1
- Issue: Vol 5, No 4 (2017)
- Pages: 16-23
- Section: Articles
- URL: https://journals.rcsi.science/turner/article/view/7669
- DOI: https://doi.org/10.17816/PTORS5416-23
- ID: 7669
Cite item
Abstract
Background. Complications after microsurgical toe-to-hand transfer is a problem for which there is no common approach to treatment.
The aim of this study was to analyze the ischemic complications after microsurgical operations in children with pathologies of the hand to improve the quality of surgical treatment.
Materials and methods. From 2007 to 2016, we performed 210 microsurgical toe-to-hand transfers involving 306 transplants, 267 (87.3%) of which were performed in patients with congenital pathologies and 39 (12.7%) in patients with post-traumatic deformities of the hand. In total, 352 fingers were reconstructed.
Results. Blood supply disturbance following toe transplants occurred in 19 (6.2%) of the 306 transplants, most often in the early postoperative period (73.7%). The main cause of microcirculatory disorders was thrombosis of the venous or arterial trunks (8 cases). In 6 patients, the blood supply disturbance occurred because of thrombosis of autovenous grafts. Two patients underwent necrectomy at days 7 and 18 because conservative and operative treatments were not successful.
Conclusion. The treatment method of choice after the first appearance of signs of blood supply disturbance in a transferred toe is conservative therapy, which includes disaggregants, anticoagulants, and hirudotherapy. Conservative therapy should be performed within 3 hours from the beginning of ischemia; if ischemia is absent, the patient must undergo surgery. The operation includes soft tissue decompression, mechanical pumping across vascular anastomoses, and if necessary, excision of the abnormal vessel part with subsequent autoplasty.
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##article.viewOnOriginalSite##About the authors
Sergey I. Golyana
The Turner Scientific Research Institute for Children’s Orthopedics
Author for correspondence.
Email: ser.golyana@yandex.ru
MD, PhD, scientific supervisor Department of Reconstructive Microsurgery and Hand Surgery
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Tatiana I. Tikhonenko
The Turner Scientific Research Institute for Children’s Orthopedics
Email: Tikhonenko_turner@mail.ru
MD, PhD, leading research associate of the Department of Reconstructive Microsurgery and Hand Surgery
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Anton V. Govorov
The Turner Scientific Research Institute for Children’s Orthopedics
Email: agovorov@yandex.ru
MD, PhD, orthopedic and trauma surgeon of the Department of Reconstructive Microsurgery and Hand Surgery
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Natal’ya V. Zaytseva
The Turner Scientific Research Institute for Children’s Orthopedics
Email: zaiceva.n@mail.ru
MD, anaesthesiologist
Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603Aleksey V. Balashov
Children’s City Hospital No 1
Email: balashov.md@mail.ru
MD, PhD, orthopedic and trauma
Russian Federation, Saint PetersburgReferences
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