The Journal of hand surgery
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Twenty-three toe-to-hand transfers performed in 21 children were monitored after surgery using differential pulse oximetry for 4 to 12 days. Pulse rate recorded by the pulse oximetry monitored the patency of the arterial anastomosis, whereas oxygen saturation (SaO(2)) corresponded to the patency of the venous anastomosis; these were both compared with the systemic pulse rate and oxygen saturation recorded by a second control pulse oximeter probe attached to a contralateral finger or toe. ⋯ If the oxygen saturation of the toe transfer decreases below the oxygen saturation measured by the control pulse oximeter and this differential is sustained over a period of time, thrombosis of the venous anastomosis should be suspected. Differential pulse oximetry appears to be superior to temperature monitoring and percutaneous and laser Doppler monitoring and provides the most simple and continuous technique of noninvasive postoperative monitoring of toe-to-hand transfers in children requiring reconstruction of traumatic or congenital deformities.
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The aim of this study was to investigate the potential for stimulating axonal regeneration in the context of end-to-side coaptation using a combination of nerve growth factor and ciliary neurotrophic factor in the rat sciatic nerve model. Four experimental groups (n = 8) were used: end-to-side coaptation only, end-to-side coaptation plus growth factor injection, primary repair, and nontransferred gap control. Twenty weeks after surgery histologic analysis showed that the ratio of axon density was significantly increased for the growth factor injection group. ⋯ Another conclusion is that contamination from the proximal peroneal stump may explain the regeneration observed in the end-to-side model. Further study using retrograde labeling is needed to establish the origin of the regenerating axons. Finally, evidence suggests that regenerating axons can use the epineurium of an intact nerve to bridge a gap in continuity.