Document Detail

Acute and chronic ischemia of the hand: pathophysiology, treatment, and prognosis.
MedLine Citation:
PMID:  1748754     Owner:  NLM     Status:  MEDLINE    
Fifty consecutive patients with acute and chronic ischemia of the hand were investigated by Allen testing, Doppler ultrasound, digital plethysmography, and angiography over a 4-year period. The pathophysiologic mechanism responsible for the ischemia was determined to be emboli in 6%, vasospasm in 10%, thrombosis or "sludging" in 28%, occlusive disease in 26%, and occlusive disease associated with either vasospasm or external compression in 30%. Ten patients required emergency medical treatment with intraarterial streptokinase, intravenous heparin, or dextran 40 and continuous stellate ganglion blocks, and three patients required emergency microsurgical revascularization because of radial artery thrombosis. Patients with chronic ischemia of the hand were maintained on nifedipine, 30 to 60 mg daily, and pentoxifylline, 1200 mg daily. Seven patients underwent digital sympathectomy and 14 patients underwent microsurgical revascularization as prophylactic procedures for chronic digital ischemia. Amputations were required in 18 patients because of end-stage gangrene. Long-term follow-up revealed a 20% incidence of recurrent digital ulcerations. There have been six deaths during follow-up, five of them due to myocardial infarction; this reflects the underlying systemic arteriopathy in many of these patients.
N F Jones
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of hand surgery     Volume:  16     ISSN:  0363-5023     ISO Abbreviation:  J Hand Surg Am     Publication Date:  1991 Nov 
Date Detail:
Created Date:  1992-01-23     Completed Date:  1992-01-23     Revised Date:  2009-06-08    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1074-83     Citation Subset:  IM    
Division of Plastic and Reconstructive Surgery, University of Pittsburgh, PA.
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MeSH Terms
Acute Disease
Chronic Disease
Follow-Up Studies
Hand / blood supply*
Ischemia* / diagnosis,  etiology,  physiopathology,  surgery
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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