Neil Tarabadkar1, Matthew L Iorio, Kenneth Gundle, Jeffrey B Friedrich. 1. Seattle, Wash.; and Boston, Mass. From the Division of Plastic Surgery and the Department of Orthopaedic Surgery, University of Washington Medical Center; and the Division of Plastic Surgery, Beth Israel Deaconess Medical Center.
Abstract
BACKGROUND: Efficient identification of dysvascular finger(s) following trauma is critical for triaging surgical care and optimizing patient outcomes. The authors designed a study evaluating an objective measure of digital hypoxia followed by surgical exploration and correlation with vascular injury. METHODS: Patients with lacerating or penetrating trauma to the hand or digits were examined. A pulse oximeter was applied to the injured digit, and the oxygen saturation was recorded. The nonparametric Wilcoxon rank sum test was used to assess for differences in pulse oximetry for digits with and without an ischemic-type injury that required repair. Receiver operating characteristic curve analyses were used to determine cut-points. RESULTS: Twenty patients with digital lacerations were enrolled, with a total of 49 digit measurements of pulse oximetry. Twelve dysvascular injuries requiring repair or amputation were confirmed in the operating room. There was a significant difference in pulse oximetry measurement in digits with (76 percent; 95 percent CI, 64 to 87 percent) and without (98 percent; 95 percent CI, 97 to 99 percent) ischemic injury (p < 0.001). Injured digits ranged in pulse oximetry values from 53 to 92 percent. CONCLUSIONS: Pulse oximetry is widely available and offers an objective measure of tissue oxygenation. No digit with a pulse oximetry value of at least 95 percent had an ischemic injury, and all digits with a pulse oximetry value of 84 percent or lower required operative vascular treatment. Based on these data, pulse oximetry should be adopted as a routine measure for the evaluation and communication of a potentially dysvascular digit.
BACKGROUND: Efficient identification of dysvascular finger(s) following trauma is critical for triaging surgical care and optimizing patient outcomes. The authors designed a study evaluating an objective measure of digital hypoxia followed by surgical exploration and correlation with vascular injury. METHODS:Patients with lacerating or penetrating trauma to the hand or digits were examined. A pulse oximeter was applied to the injured digit, and the oxygen saturation was recorded. The nonparametric Wilcoxon rank sum test was used to assess for differences in pulse oximetry for digits with and without an ischemic-type injury that required repair. Receiver operating characteristic curve analyses were used to determine cut-points. RESULTS: Twenty patients with digital lacerations were enrolled, with a total of 49 digit measurements of pulse oximetry. Twelve dysvascular injuries requiring repair or amputation were confirmed in the operating room. There was a significant difference in pulse oximetry measurement in digits with (76 percent; 95 percent CI, 64 to 87 percent) and without (98 percent; 95 percent CI, 97 to 99 percent) ischemic injury (p < 0.001). Injured digits ranged in pulse oximetry values from 53 to 92 percent. CONCLUSIONS: Pulse oximetry is widely available and offers an objective measure of tissue oxygenation. No digit with a pulse oximetry value of at least 95 percent had an ischemic injury, and all digits with a pulse oximetry value of 84 percent or lower required operative vascular treatment. Based on these data, pulse oximetry should be adopted as a routine measure for the evaluation and communication of a potentially dysvascular digit.