J Reconstr Microsurg 2023; 39(05): e1-e2
DOI: 10.1055/a-1886-5858
Letter to the Editor

Use of Doppler Ultrasound for Early Rehabilitation of Replanted Hand and Finger

Takashi Kageyama
1   Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama, Japan
Hokuto Morii
1   Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama, Japan
Koichi Inokuchi
1   Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama, Japan
› Author Affiliations

We read the article entitled “Using Duplex Ultrasound for Recipient Vessel Selection” by Hong et al with great interest.[1] They reported that Duplex ultrasound (US) could be a reliable tool for reconstructive surgeons to choose recipient vessels. Since the introduction of new types of flaps such as the perforator-to-perforator flap and superthin flap, detailed evaluation of the vascularity of flap and recipient vessels gets more and more essential and various kinds of US could be applied for preoperative evaluation. US examination is safe for patients, easy to perform, does not take much time, and detects very small vessels with a diameter of 0.5 mm.[2] Moreover, at our hospital Doppler US could also be applied to prevent vascular spasms during rehabilitation after finger or hand replantation. Many hand surgeons kept replanted fingers immobilized for 5 to 7 days after fingers and hand replantation.[3] One of the reasons for this immobilization was that movement of the fingers might cause spasms or thrombosis of anastomotic vessels and lead to necrosis of tissues. However, delayed rehabilitation could cause adhesion of flexor and extensor tendon and joint contractures, and lead to impairment of hand function. Therefore, early mobilization of fingers accompanied with assessments of arterial patency is very important in the field of rehabilitation of finger and hand replantation. To overcome this challenge, we used Doppler US for the assessment of the blood flow of anastomotic vessels during the extension and flexion of joints near the anastomotic area.

This method was performed as follows. The first step was to set the Doppler US on the digital artery distal to the anastomotic area. The second step was to make fingers extend or flex for rehabilitation on postoperative day 1 to 2 while listening to the sound of pulsation of the anastomosed digital artery ([Fig. 1]). If the sound of pulsation diminished or weakened during the extension of the finger, rehabilitation should be stopped because the tension in vessels was too strong to cause spasm. If strong pulsation was continued during the movement of fingers, the blood flow of replanted fingers was reliable so early rehabilitation should be continued to prevent tendons adhesions and joint contractures.

Zoom Image
Fig. 1 Early rehabilitation using Doppler ultrasound.

This early rehabilitation method using Doppler US might contribute to a good functional outcome of replanted fingers and hands. Motions of the fingers especially extension could cause anastomosed vessels to extend and might lead to spasm or thrombosis of anastomotic vessels, so evaluation of good blood flow of anastomosed vessels during movement of fingers is very important for safe rehabilitation. Although further studies are required to survey the efficacy of this rehabilitation, this method could be a useful tool for tissue reconstruction with good functional outcomes.

Prior Presentations


Date Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Publication History

Received: 05 June 2022

Accepted: 23 June 2022

Accepted Manuscript online:
28 June 2022

Article published online:
26 September 2022

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  • References

  • 1 Hong JP, Kim HB, Park CJ, Suh HP. Using Duplex ultrasound for recipient vessel selection. J Reconstr Microsurg 2022; 38 (03) 200-205
  • 2 Hayashi A, Visconti G, Giacalone G, Hayashi N, Yoshimatsu H. Recent advances in ultrasound technology: ultra-high frequency ultrasound for reconstructive supermicrosurgery. J Reconstr Microsurg 2022; 38 (03) 193-199
  • 3 Prsic A, Friedrich JB. Postoperative management and rehabilitation of the replanted or revascularized digit. Hand Clin 2019; 35 (02) 221-229