S.E.R. Hovius

The acute effect of cigarette smoking on the microcirculation of a replanted digit

Thirty-one patients who had undergone digital replantation or revascularization volunteered to participate in a study of the acute effect of smoking on the microcirculation of the skin of replanted fingers. Fourteen were smokers and 17 were nonsmokers at the time of the study. Blood flow was assessed by means of the laser Doppler flowmeter under standard conditions. Each smoker inhaled 2 cigarettes. During smoking of the first and second cigarettes a mean decrease in laser Doppler flow of 8% and 19%, respectively, was found, whereas the nonsmokers showed a slight increase of 4% and 4%, respectively. Ten minutes after the last cigarette almost no recovery could be detected. The negative effect of smoking on the microcirculation in replanted digits proved to be more pronounced in the patients operated on more recently. This experiment confirms that smoking after replantation surgery should be prohibited to guarantee optimal circulation.

Acute effects of cigarette smoking on microcirculation of the thumb

The acute effect of smoking on the microcirculation of the skin of the thumb was investigated in healthy volunteers. Twenty-two were smokers and 10 were non-smokers. The flow was assessed by means of laser Doppler flowmetry. The smokers inhaled 2 cigarettes. During smoking of their first and second cigarette respectively, a mean decrease in laser Doppler flow of 23.8% and 29.0% was seen (p = 0.03; p = 0.01). Ten minutes after smoking this decrease was recovered by half. This experiment confirms that one should prohibit smoking of cigarettes pre- and postoperatively for optimal wound healing conditions.

Results of treatment of 48 ring avulsion injuries

A retrospective study of 48 patients with ring avulsion injuries was performed. Patients were grouped according to severity of damage. Revascularization with interposition grafts was performed in all patients where indicated. In contrast to the experience of others, even class III lesions (total avulsion) were salvaged.

Results of small-joint arthrodesis: Comparison of Kirschner wire fixation with tension band wire technique

In a retrospective study the results of 203 interphalangeal and metacarpophalangeal arthrodeses performed between 1977 and 1990 were reviewed. Eighty-three percent of the cases involved severe hand injuries. Two fixation techniques were used. During the early period, 143 arthrodeses were performed with percutaneous Kirschner wires, combined with either interosseous wiring or plaster of Paris. From 1987 to 1990, 60 arthrodeses were performed with the use of tension band fixation. In the Kirschner wire group 18% of the patients had pin-track infections, and in 15% rearthrodeses were necessary. In the tension band group 2% of the patients had an infection, and in 5% rearthrodeses were performed. Both the infection rate and the rearthrodeses rate were significantly lower in the tension band group than in the Kirschner wire group. Judging from this study, the tension band fixation technique is the method of choice for arthrodeses of the small finger joints.

The predictive value of the laser Doppler flowmeter for postoperative microvascular monitoring

Reliable postoperative monitoring in microvascular surgery is necessary to improve the low success rate of reexploration after vascular compromise. The use of laser Doppler flowmetry has been evaluated in this study. From November 1985 to January 1988, 79 microvascular operations were monitored postoperatively. These consisted of 45 replants and revascularizations in 34 patients, as well as 34 free vascularized tissue transfers. In the replant and revascularization group, a statistically significant difference in laser Doppler flowmetry readings has been demonstrated between well-vascularized and circulatory impaired patients (p<0.001). In this study a reliable critical (alarm) value could be defined for replants and revascularizations with a sensitivity of 93% and a specificity of 94%. This critical alarm value can be adjusted according to the individual surgeons attitude toward reexploration. Similar laser Doppler flowmetry characteristics were seen in patients with free vascularized tissue transfers; however, the numbers in this part of the study were too small to define reliable critical alarm values. The laser Doppler flowmeter is recommended for the postoperative evaluation of tissue after microvascular anastomoses, as it indicates vascular occlusion at an early stage where reexploration is worthwhile.

Heat recordings at tips of Kirschner wires during drilling through human phalanges

The temperature was recorded during drilling through fresh human cadaveric fingers with thermocouples built in the tips of Kirschner wires. High temperatures up to 190 degrees C were measured. This may contribute to osteonecrosis around the wires and to loosening and infections.

Replantation of the radial side of the hand in the rhesus monkey: Anatomical and functional aspects: A preliminary study to composite tissue allografting

Before human hand transplantation can even be considered, an appropriate research model must be studied in-a non-human primate. The first ray of the hand, augmented with a radial forearm flap, was chosen as a functional composite tissue graft. Four technically successful replantations of the radial unit have been carried out. One monkey died on the first post-operative day due to cardiac arrythmia. Normal wound healing occurred in the other three animals. In three monkeys, functional sensory and motor recovery was almost complete. The monkeys were able to pick up small particles of food with the index finger and thumb. It is suggested that this model could be used for allogeneic composite tissue transplantation in a non-human primate.

Dermatography with Penta-Monogalloyl-Glucose as a New Treatment for the Removal of Color Pigments in Eyebrows

The removal of disfiguring tattooed eyebrows of 21 patients by means of dermatography is discussed. The color pigments were removed using penta-monogalloyl-glucose, a tannic acid. No side effects were found. Local anesthesia was not necessary. Biopsies of five patients with inflammatory reactions to the tattooed pigments were taken before treatment. A 5-year follow-up showed that the results were lasting and cosmetically satisfactory.

Dermatography as a New Treatment for Trichotillomania

The treatment of 38 trichotillomania patients with dermatography—medical tattooing techniques—is discussed. The location was in the eyebrows. After the completion of treatment all patients stopped plucking the eyebrows. In a five-year follow-up none of the patients showed a relapse. With dermatography, no anesthetics are necessary because the pain level is generally bearable. The cosmetic and aesthetic improvement achieved by dermatography was remarkable.