The Clinical Study On Reparation Of The Limb Blood Injury Using Long Vessel Transplantation

Objective:To investigate the clinical and therapeutic significance of rebuilding the limb blood supply by long vessel transplantation. Currently, it is well accepted in the field of orthopedics that if the loss of vessel is more than 2cm after debridement, the vessel transplantation should be applied according to the angiostomy without tension; normally the intact side great saphenous vein transplantation is the first choice. However, the longer grafting, the little clear rate, so the long vessel transplantation is a dilemma of vessel transplantation. Our project is to investigate the possible changes and corresponding applications of long vessel transplantation via clinical practice. Our overall goal is to extend the period of keeping limb and refreshing the function compared with traditional operation.Method: Using the method of clinical prospective historical cohort study, we chose 60 patients continually in hospital from January, 2003 to June, 2006. The patients were divided into 3 groups according to the extent of vessel loss after long vessel transplantation. Experimental group: the length of transplantated intact side great saphenous vein is longer than 10cm; control groupâ‘ : the length of transplantated intact side great saphenous vein is from 2cm to 10cm. contrast teamâ‘¡: direct anastomosis. To compare the long vessel transplantation and short vessel transplantation, we observed the blood supply and function of the injured limb by 6 to 42 months' clinical follow-up, and recorded the change of transplanted vessel by electro microscopy and color Doppler from 6 to 12 months after operation.Result: All of surviving limb remained original length, healthy blood supply of ending limb and no incidence of amyotrophia. The effective rate of experimental group was 87.5%, lower than control groupâ‘ (95.83%) andâ‘¡(100%). Hoverer, the result was not statistically significant. Therefore, we can not take it for granted that the effective rate of long vessel transplantation is lower than that of short vessel transplantation and direct anastomosis. Besides, our data inferred that long vessel transplantation has its potential dangerous factors. The observation by electro microscopy showed that there was obvious vessel hyperplasia in the wall of long transplanted vessel, and the extent of hyperplasia of was stronger than that of short vessel transplantation.Conclusion: In the aspect of clinical practice, if the injured limb vessel is serious, the long vessel transplantation is a feasible and reliable method to rebuild blood supply for limb as long as operation is strict, the supervision after operation is careful and the '3-anti therapy' is applied.