ARTERIAL RECONSTRUCTION IN THE ISCHEMIC HAND AND WRIST - EFFECTS ON MICROVASCULAR PHYSIOLOGY AND HEALTH-RELATED QUALITY-OF-LIFE

Patients were evaluated before and after arterial reconstruction surge ry (1) to define the physiology of the digital microcirculation in chr onic subcritical ischemia, (2) to demonstrate the short-term effects o f successful arterial reconstruction on microvascular flow, and (3) to document the effects of surgery on symptoms, function, and health-rel ated quality of life. Arterial insufficiency was the result of a proxi mal reconstructible occlusive lesion, 1 or more distal unreconstructib le occlusions, and secondary reactive vasospasm. Microvascular physiol ogy was evaluated by monitoring digital temperatures, microvascular pe rfusion (laser Doppler fluxmetry) and perfusion patterns (laser Dopple r perfusion patterns (laser Doppler perfusion imaging). Following succ essful vascular reconstruction, digital temperatures and microvascular perfusion improved significantly, approaching control levels. Althoug h cold sensitivity was unchanged, symptoms decreased and upper extremi ty function and health-related quality of life improved after successf ul proximal reconstruction in patients with 2-level arterial occlusion . Copyright (C) 1998 by the American Society for Surgery of the Hand.