fibrin and Finger-Injuries

The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis.. 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding.. Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group.. The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.

Topics: Adult; Amputation, Traumatic; Angiography; Contrast Media; Crush Injuries; Degloving Injuries; Edema; Female; Fibrin; Finger Injuries; Fingers; Fluoroscopy; Hemorrhage; Hernia; Humans; Male; Microscopy; Middle Aged; Prospective Studies; Regional Blood Flow; Triiodobenzoic Acids

The healing process of osteochondral fracture was studied experimentally and clinically, using fibrin adhesive system (FAS) containing highly concentrated and freeze-dried fibrinogen, thrombin and factor XIII. Osteochondral fractures were made in the femoral condyle of the rabbit. Most of the adhered fibrin was gradually absorbed at the fracture site and at the same time was replaced with granulation tissue containing abundant capillaries, fibroblasts and osteoblasts, by the 10th day. Complete fracture healing was achieved histologically in one month. Fifteen cases of intraarticular osteochondral fractures in the hand were treated with FAS clinically. Complete bony union was obtained in all cases at 3 to 6 weeks postoperatively. The range of motion was limited in 3 cases, but was excellent in the other 12 cases. From our experimental and clinical results, it appears that FAS may produce no obstructive effects in bony healing. Management of intraarticular osteochondral fixation would be much easier by using FAS than by the conventional fixation materials such as metal screws or K-wire.

Topics: Adolescent; Adult; Animals; Cartilage, Articular; Child; Female; Fibrin; Finger Injuries; Fractures, Cartilage; Fractures, Open; Hand Injuries; Humans; Knee Injuries; Male; Middle Aged; Postoperative Period; Rabbits; Swine; Tissue Adhesives; Wound Healing

We developed a new technique of venous interposition graft where the principle of sleeve anastomosis was applied at the proximal suture site and fibrin glue was used at both suture sites to prevent leakage. An advantage of this procedure was a reduction in the number of stitches, which reduced operative time and obtained good vascular healing. Since in an animal experiment a high patency rate of 97% was obtained, we applied the procedure to a clinical case with complete amputation at the PIP joint level of a long finger. Good recirculation was seen on angiography 6 weeks postoperatively.

Topics: Adhesives; Adolescent; Animals; Carotid Arteries; Fibrin; Finger Injuries; Humans; Jugular Veins; Male; Rats; Rats, Inbred Strains; Replantation; Suture Techniques; Veins