Complete section of proper palmar digital pedicles: Correlation between arterial patency and sensory recovery

• Published in: Hand surgery and rehabilitation 2017-04, Vol.36 (2), p.136-140
• Main Authors: Pomares, G., Dap, F., Dautel, G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cold Temperature - adverse effects; Doppler; Echo-Doppler; Female; Follow-Up Studies; Hand - blood supply; Hand Injuries - surgery; Humans; Male; Middle Aged; Nerf; Nerve; Nerve Regeneration; Neuralgia - etiology; Neurologic Examination; Neuroma - etiology; Patency; Pedicle; Perméabilité; Pédicule; Recovery of Function; Retrospective Studies; Thrombosis - diagnosis; Vascular Patency; Vascular System Injuries - surgery; Young Adult
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2016.12.001

Wounds to proper palmar digital (PPD) pedicles are frequent surgical emergencies. A correlation between arterial patency and nerve regeneration, however, has never been demonstrated. Forty-seven patients presenting complete section of a PPD pedicle and having undergone surgical repair of both elements were followed-up at a minimum of one year postoperatively. Doppler ultrasound examination studied arterial patency as well as the degree of stenosis. Neurological examination determined the BMRC score and the existence of cold intolerance, symptomatic neuroma and neurogenic pain. In 32 cases, the artery was permeable; in the remaining 15, arterial thrombosis was identified. In 14 out of the 32 permeable-artery subjects, stenosis had no significant effect; in the remaining 18 cases, circulation was reduced. BMRC scores showed 11 S4 cases, 16 S3+, 16 S3 and 4 S2. Twenty-nine cases of intolerance to cold were identified, along with two cases of neurogenic pain and 17 cases of symptomatic neuroma. A statistically significant correlation was shown between arterial patency and BMRC scores (Chi-square, P=0.0221) and neurological symptoms appeared to be linked to the degree of stenosis. Favorable BMRC scores were observed where the artery was permeable, notably where blood flow was not modified below the repair site. This observation also seemed valid regarding disabling neurogenic symptoms. Les plaies des pédicules digitaux palmaires propres sont une urgence fréquente. La corrélation entre la perméabilité artérielle et la régénération nerveuse des pédicules digitaux n’a jamais été démontrée. Quarante-sept patients présentant une section complète d’un pédicule digital avec une réparation des deux éléments ont été revus à un an minimum de l’intervention. Un examen écho-Doppler étudiait la perméabilité de l’artère et le degré de sténose. Une évaluation neurologique déterminait le score BMRC, l’existence d’une intolérance au froid, d’un névrome symptomatique, et de douleurs neurogènes. L’artère était perméable dans 32 cas, et une thrombose artérielle était identifiée dans 15 cas. Dans 14 cas, il n’était pas trouvé de sténose significative. Dans 18 cas, il existait un retentissement de cette sténose. L’évaluation du score BMRC trouvait 11 S4, 16 S3+, 16 S3, et 4 S2. Vingt-neuf cas d’intolérance au froid ont été identifiés, deux cas de douleurs neurogènes, et 17 névromes symptomatiques. Une corrélation statistique existait entre la perméabilité artérielle et le score BMRC