Revascularization of the hand by intra-arterial injection
Received: 10 August 2009 / Accepted: 3 August 2010 / Published online: 18 December 2010
A BSS patient, 20 years old, male, presented at the E.R.
after an accident at work with traumatic slough of the left
hand (crushing injury by hydraulic splitter of firewood).
During physical examination, the patient presented
hemodynamic stability with injury of the palmar region of
the left hand with signs of devascularization of the second
and third fingers.
The X-ray showed fracture of the proximal phalanx of
the first, second and third fingers.
Two hours and 30 min after entering the E.R. and about
3 h and 30 min after the traumatic injury, the patient was
of the fractures were performed. No tendon vascular and
nerve injuries of the left hand were found (Fig. 1);
however, intra-arterial thrombi could be seen in the
common palmar digital artery (3 mm) and palmar digital
arteries of the second (2 mm) and third (2 mm) fingers
without apparent transmural injury of the vascular wall
Five thousand units of Heparin was injected into the
radial artery showed clear improvement of vascularization
with perfusion of the second and third fingers of the left
hand after about 5 min (Fig. 3). Papaverine was also
applied topically on this vessel as a vasodilator therapy.
The patient was hospitalized for 8 days with a
continuous iv perfusion of neodextril (Dextran), showing
good perfusion and no signs of ischemia (Fig. 4).
Reversibility of the thrombotic process relates directly to
the ischemic tissue period, and therefore, the main objective
is to reverse this process as quickly as possible.
Nowadays, the endothelium is known to play an active
role in the physiopathological process of haemostasis,
thrombosis, inflammation and immune response.
In traumatic injuries, stretching and dissection of the
internal layer of the endothelium occurs leading to an
increasing release of vasoconstrictors and exposure of
myofibrils and collagen of the basal membrane. Mediated
by the Von Willebrand factor, platelet adhesion to sub-
endothelium occurs as well as the activation of membrane
receptors in platelets, platelet aggregation and addition of
fibrin with consequent formation of a fibrin–platelet
thrombus (vascular thrombosis)[3, 6].
There is some controversy concerning thrombosis treat-
ment related to pharmacological and surgical procedures;
however, it is widely accepted that maintenance of an
adequate blood volume and perfusion pressure allied to
keeping body temperature are key measures [1, 2, 5, 7].
Concerning non-pharmacological modalities, endovas-
cular or surgical thromboembolectomy or arterial bypass
procedures are used to restore blood flow to the ischemic
extremity . A micro-Fogarty catheter could also be used
to remove larger thrombi.
Pharmacological agents that reduce adhesion and platelet
aggregation such as acetylsalicylic acid (aspirin), ticlopi-
dine, prostacyclin (or similar), sulfinpyrazone, dipyrida-
H. Costa (*)
Plastic Reconstructive and Maxillofacial Surgery Unit,
Centro Hospitalar de Vila Nova de Gaia/Espinho EPE
Rua Conceição Fernandes,
4434-502 Vila Nova de Gaia, Portugal
Eur J Plast Surg (2012) 35:195–197