Application of pre-operative color Doppler-guided analysis of vascular distribution in syndactyly
10.3760/cma.j.cn114453-20230613-00128
- VernacularTitle:彩色多普勒超声成像在先天性并指术前血管评估中的应用
- Author:
Jinping WANG
1
;
Fei YIN
;
Ximing WANG
;
Jun GU
;
Hai HUANG
Author Information
1. 无锡市第九人民医院功能科，无锡 214062
- Keywords:
Hand deformities, congenital;
Syndactyly;
Ultrasonography, Doppler, color;
Common palmar digital artery
- From:
Chinese Journal of Plastic Surgery
2023;39(12):1331-1336
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the vascular distribution of palmar digital arteries in syndactyly through color Doppler ultrasound angiography and make the classification according to the level of artery bifurcation points, discusse its clinical significance.Methods:A retrospective analysis was performed for the data of children with congenital and digital malformations admitted to Wuxi Ninth People’s Hospital from January 2017 to December 2022. Preoperative vascular ultrasonography of the hand was performed to locate the bifurcation point of the common palmar digital artery in the digital webbed area. The vascular conditions were classified according to the distance between the bifurcation point and the 1/3 point of the proximal phalangeal as the reference, such as normal type (<0 mm), mild reduction type (0-5 mm), moderate decrease type (6-10 mm), and severe reduction type (>10 mm), absent type (only 1 artery between the fingers). The total variation of the bifurcation point of the common palmar digital artery in the children, as well as the proportion of different vascular condition subtypes were recorded. According to the classification of blood vessels, the corresponding operation plan was made. The positioning accuracy of color Doppler ultrasound angiography was evaluated based on the gold standard of common palmar digital artery bifurcation points detected during operation. Complications such as postoperative infection, flap necrosis, finger vasospasm and the morphology of finger web at the last follow-up were observed. Descriptive statistical analysis was used.Results:A total of 123 children with 181 finger webs were enrolled, including 72 males and 51 females, aged 10-28 months. There were 55 cases of simple type, 36 cases of complex type (bone) and 32 cases of Poland syndrome. Color Doppler ultrasound angiography showed that the total variation rate of the common palmar digital arterial bifurcation point was 24.3% (44/181), of which 11.6% (21/181) were mildly reduced type, 8.3% (15/181) were moderately reduced type, 3.3% (6/181) were severe reduced type, and 1.1% (2/181) were absent type. The vascular variation rates of simple syndactyly, bony syndactyly, and Poland syndrome were 0 (0/55), 19.5% (7/36), and 41.1% (37/90), respectively. Compared with the actual situation during surgery, the positioning accuracy of color Doppler ultrasound angiography was 100%. All pediatric surgeries were successfully completed, and the flaps and skin grafts survived smoothly. There were no postoperative complications such as infection, vascular crisis, or finger necrosis. All patients were followed up for 6 to 27 months, with an average of 13.5 months. At the last follow-up, the depth, width, and slope of the fingerwebs were all close to normal.Conclusion:Congenital syndactyly has a high variation rate at the bifurcation point of the common palmar digital artery, and bony syndactyly and Poland syndrome refer to the need to improve preoperative vascular evaluation. Color Doppler ultrasound angiography has the advantages of no radiation, high sensitivity and low price, and the vascular typing based on color Doppler can improve the reliable basis for the formulation of clinical surgical plans.
