Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
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"Тrauma" Том 15, №4, 2014

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Application of ultrasound diagnostics in hemodynamic disturbances after operation in heavy hand injuries

Authors: Pasternak W.W., Borzykh A.W., Kowalchuk D.Y., Solowyow I.O., Oprischenko O.O., Warin W.W. - Donetsk National Medical University named by M. Gorky, Ukraine

Categories: Traumatology and orthopedics

Sections: Specialist manual

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The ultrasound diagnostics of the staggered segment in в-mode does not carry meaningful diagnostic information because of substantial decline of echogenity, heterogeneity of structure, displacement or complete absence of natural anatomic reference-points, however allows to educe structures probably being blood vessels. Doppler allows differentiate vessels with a blood stream in the presence of color structure, corresponding locomotive liquid (to blood). Doppler visualization of stream is the convincing fact of presence of blood stream, that is specially important for estimation in difficult clinical cases. Absence of color stream visualization testifies the absence of blood stream in the staggered segment and can serve ground for establishment of testimonies to the repeated surgical interference.

Based on Donetsk’ s regional clinical trauma hospital department of Hand Microsurgery patients in 2013 were carried out a series of ultrasound. They were made on the 5th day after surgery and at 6 months (check-ups). Total ultrasound Doppler ultrasound on day 5 were carried out 8 patients, 2 of them with the first finger replantation and 6 fractures with blood subcompensation, with varying degrees of blood flow. After 6 months, the study was conducted in six of them. For the studies used ultrasound scanner Nemio X6, model SSA-580A Toshiba's line sensor with an operating frequency of 5-12 MHz.

In the study on the 5th day of a patient lying position (due to the requirements of the postoperative patients management after replantation), or sitting among patients with opened damages in a more recent time — sitting. The patient's hand and forearm were placed on the table surface. Sensor placed on the palmar surface of the hand to explore the state of the soft tissue (subcutaneous tissue, muscle, fascia, flexor tendons, etc.) in the B-mode. Next to research extensor tendons sensor placed on the back surface. For vascular ultrasonography probe is placed on the sides of the fingers. The position sensor is defined as the perpendicular surface of the body in the scanning area. To optimize visualization used rubber tank filled with water or "gel cushion". Methodology "gel cushion" was arrangement scanning the surface of the sensor at a distance of 0.5-1.0 cm from the skin surface, with the space therebetween filled with a contact gel.

Blood vessels (arteries and veins) in the longitudinal scan visualized as linear, transverse lined rounded education with clear hyperechogenic boundaries. However, in the area of operations due to the development of edema, as well as due to the small diameter of the lumen and vessel wall thickness of small significant difficulties arise in the differentiation of vessels from other hypoechogenic structures, homogeneous and inhomogeneous structure corresponding microcavities filled with liquid (hematoma, tenosynovitis, an area of inflammation).

Thus, ultrasound surgery zone B-mode allowed in all analyzed cases get echographic picture of soft tissue and vascular regions of interest, which was detailed interpretation difficult.

In the energy Doppler of 3 patients were able to confirm and document the existence of blood flow through the arteries, including the restoration, and in one case of them also able to identify and venous blood flow at the level of the metacarpophalangeal joints. It should be noted that two of these patients, clinical data was insufficient for reliable detection of the blood flow.

Most informing to determination the blood stream there is power Doppler in the vessels of the staggered segment, is beneficial to colored Doppler subzero speeds of bloodstream. Researches of blood vessels of the staggered hand segment in the impulsive Dopplerspectrography stream mode representative are not enough for inconnection with technical difficulties in the receipt of correct spectral curve.



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