Metabolism in the hand tissues and functional microcirculation recourses in patients with sequelae of cold injury treated with the Ilizarov method

Objective To explore metabolism and microcirculation of the hand in patients with remote effects of severe cold injury treated with the Ilizarov method using functional tests. Material and methods Metabolism and microcirculation of the hand were studied in 19 patients with remote effects of severe cold injury treated with the Ilizarov method. The patients’ age ranged from 24 to 46 years (32.8 ± 2.9 years). Control group consisted of 14 normal peers. Depending on finger stump length, presence of contractures in adjacent joints and postlengthening basal syndactyly techniques employed for treatment included finger stump lengthening (4 observations of less than 30 mm stumps and 10 observations of more than 30 mm stumps); finger stump lengthening followed by plasty of web space in 3 patients; finger stump lengthening and repair of adduction contracture in 2 cases. Laser Doppler Flowmetry (LDF) BLF21 (Transonic Systems Inc., U.S.A.) was used to assess microcirculatory function. Local vascular occlusion test was applied, blood flow recorded at rest and after 3 minute ischemia, and Peak Capillary Blood Flow Index calculated (PBFI, % = CBFpeak/CBFrest × 100 %), ∆ t, sec - period from occlusion relief to maximal runup of capillary blood flow. A Doppler ultrasound (DUS) using diagnostic Minimaxdoppler K device (St.Petersburg) was used to assess peripheral hemodynamics of finger and stump arteries. Results DUS showed signs of vasoconstriction of digital arteries. Period of CBF semi-recovery and length of reactive hyperemia were sharply decreased. Transcutaneous polarography showed prevailing anaerobic metabolism with two-fold decrease in pO2 half-life and two-fold increase in pO2 semi-recovery, and oxygen exhaust was recorded within 2 minutes. Conclusion It was concluded that evaluation of capillary blood flow using laser Doppler flowmetry with a 3-minute vascular occlusion test was the method of choice for examination of patients with sequelae of severe cold injury of limb segments. The method allowed for assessing preclinical extent of ischemia, disorders in vascular reactivity of pre-capillary portion. A tailored approach to distraction rate under control of objective and subjective findings and microhemodynamics is essential for patients treated with transosseous distraction osteosynthesis using Ilizarov external fixator. Medications targeting the relief of vasoconstriction prescribed for patients with sequelae of cold injury treated with Ilizarov traction demonstrated hardly noticeable effect due microcirculation recourses had been largely consumed by the method of transosseous osteosynthesis. We suggest that preventive angiogenic and neurotrophic therapies can be efficient at pre-distraction stage.