Duplex ultrasound analysis of hemodynamic changes following microsurgical repair of unilateral digital artery injuries: a retrospective follow-up study
DOI:
https://doi.org/10.2340/jphs.v61.45557Keywords:
Microsurgery, duplex ultrasonography, arterial anastomosis, digital vascularizationAbstract
Background: Whether unilateral digital artery injuries benefit from surgical repair remains controversial, as perfusion is typically preserved by the remaining, contralateral artery. Evidence on the long-term patency and hemodynamic effects of reconstructed unilateral arteries is limited. This study aimed to evaluate the patency and flow characteristics of digital arteries after microsurgical repair using duplex ultrasonography.
Methods: A retrospective single-center study was conducted including patients with unilateral digital artery injuries at the level of the digit who underwent primary microsurgical anastomosis between 2017 and 2022. Patients with fractures, proximal injuries, or vein grafts were excluded. Duplex ultrasonography was used to assess arterial patency and blood flow at follow-up.
Results: Twenty-seven patients were examined at a mean follow-up of 37 months (range 16–82). Duplex ultrasonography demonstrated anterograde flow in 26 of 27 reconstructed arteries (96.3%). The median flow volume in the repaired artery (1.1 ml/min, interquartile range [IQR]: 0.5–2.8) was significantly lower than in the contralateral artery of the same digit (3.6 ml/min, IQR: 1.4–7.7) and the corresponding artery of the contralateral hand (2.8 ml/min, IQR: 1.3–6.8). No significant compensatory increase was observed in the intact artery of the injured digit compared with its contralateral counterpart.
Conclusion: Duplex sonography demonstrates that repaired unilateral digital arteries remain patent in the long term, despite reduced flow compared with contralateral controls. While the functional benefit of arterial repair remains uncertain, long-term patency suggests a potential role for repair in selected cases to support vascular integrity.
Downloads
References
Angermann P, Lohmann M. Injuries to the hand and wrist. A study of 50,272 injuries. J Hand Surg. 1993;18(5):642–644.
https://doi.org/10.1016/0266-7681(93)90024-A DOI: https://doi.org/10.1016/0266-7681(93)90024-A
Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (N Y). 2012;7(1):18–22.
https://doi.org/10.1007/s11552-011-9383-z DOI: https://doi.org/10.1007/s11552-011-9383-z
Dastagir N, Obed D, Bucher F, et al. Blood vessel injuries of the fingers: a clinical comparison of one- and two-arterial blood supply. J Clin Med. 2023;12(18).
https://doi.org/10.3390/jcm12185889 DOI: https://doi.org/10.3390/jcm12185889
Linnaus ME, Langlais CS, Kirkilas M, et al. Outcomes of digital artery revascularization in pediatric trauma. J Pediatr Surg. 2016;51(9):1543–1547.
https://doi.org/10.1016/j.jpedsurg.2016.04.011 DOI: https://doi.org/10.1016/j.jpedsurg.2016.04.011
Gelberman RH, Blasingame JP, Fronek A, et al. Forearm arterial injuries. J Hand Surg Am. 1979;4(5):401–408. DOI: https://doi.org/10.1016/S0363-5023(79)80031-3
https://doi.org/10.1016/S0363-5023 (79)80031-3
Eming SA, Martin P, Tomic-Canic M. Wound repair and regeneration: mechanisms, signaling, and translation. Sci Transl Med. 2014;6(265):265sr6.
https://doi.org/10.1126/scitranslmed.3009337 DOI: https://doi.org/10.1126/scitranslmed.3009337
Johnson KE, Wilgus TA. Vascular endothelial growth factor and angiogenesis in the regulation of cutaneous wound repair. Adv Wound Care (New Rochelle). 2014;3(10):647–661.
https://doi.org/10.1089/wound.2013.0517 DOI: https://doi.org/10.1089/wound.2013.0517
Yildiran G, Sutcu M, Akdag O, et al. Long-term outcomes of digital nerve repair accompanied by digital artery injury in flexor zone 2. Surg J (N Y). 2020;6(1):e7–e9.
https://doi.org/10.1055/s-0039-3400229 DOI: https://doi.org/10.1055/s-0039-3400229
Piquet M, Obert L, Laveaux C, et al. Influence of palmar digital artery patency on neurological recovery of palmar digital nerve lesions. Chir Main. 2010;29(2):94–99.
https://doi.org/10.1016/j.main.2009.12.004 DOI: https://doi.org/10.1016/j.main.2009.12.004
Hussain ST. Blood flow measurements in lower limb arteries using duplex ultrasound. Ann R Coll Surg Engl. 1997;79(5):323–330.
Perko MJ. Duplex ultrasound for assessment of superior mesenteric artery blood flow. Eur J Vasc Endovasc Surg. 2001;21(2):106–117.
https://doi.org/10.1053/ejvs.2001.1313 DOI: https://doi.org/10.1053/ejvs.2001.1313
Schöning M, Walter J, Scheel P. Estimation of cerebral blood flow through color duplex sonography of the carotid and vertebral arteries in healthy adults. Stroke. 1994;25(1):17–22.
https://doi.org/10.1161/01.STR.25.1.17 DOI: https://doi.org/10.1161/01.STR.25.1.17
Salehi Ravesh M, Lebenatus A, Bonietzki A, et al. High-resolution, non-contrast-enhanced magnetic resonance angiography of the wrist, hand and digital arteries using optimized implementation of Cartesian quiescent interval slice selective (QISS) at 1.5 T. Magn Reson Imaging. 2021;78:58–68.
https://doi.org/10.1016/j.mri.2021.02.008 DOI: https://doi.org/10.1016/j.mri.2021.02.008
Haldeman PB, Harfouche C, Rosales R, et al. Immediate and delayed flap reconstruction have equivalent outcomes and associated costs following soft tissue sarcoma surgery. J Surg Oncol. 2024;130(3):562–568.
https://doi.org/10.1002/jso.27770 DOI: https://doi.org/10.1002/jso.27770
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Justus Osterloh, Bastian Drollmann, Luca Kümmerl, Andreas Arkudas, Raymund E. Horch, Aijia Cai
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from 2024 all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
