Cause analysis and management of vascular crisis in digital replantation

Objective To propose prevention and management of vascular crisis according to cause analysis, and improve the survival rate of digital replantation. Methods The vascular crisis of 132 digits of 98 cases were observed during intraoperative. The replantation was performed under different time and different conditions. The causes of vascular crisis, and propose effective prevention and management of vascular crisis were restrospective analysis. Results From March 2006 to June 2007, 35 amputated digits occurred vascular crisis during intraoperative, 19 amputated digits occurred during postoperative. After using warm physiological saline and injecting the papaverine partly, we proceed operations research with regard to the non-catabatic amputated digits. As result 58 digits survived, the achievement ratio was 89.2%. From July 2007 to March 2009, 10 amputated digits occurred vascular crisis during intraoperative,5 amputated digits occurred during postoperative. After non-surgical treatment, we performed operations research regard to the non-catabatic amputated digits. After blood supply recover, we imbed PCA pump into flex tendinous sheath to avoid the occurrence of vascular crisis postoperative. As result 66 digits survived, the achievement ratio was 98.5%. postoperative 9 cases out of fullow-up, 89 cases follow up ranged from 6 to 8 months. Recovery of the hand function was good. Conclusion Good and adequate anesthetic and an appropriate ambient temperature during operation are important factors to prevent occurrence of vascular crisis in digital replantation. Paying enough attention to these factors can effectively improve the survival rate of replantatian. Key words: Digital replantation; Vascular crisis; Microsurgery