Use of nailfold capillaroscopy for the assessment of patients undergoing digit replantation and revascularization
Muhammed Köroğlu1
, Mustafa Karakaplan1, Sezgin Zontul2, Ömer Acet1, Hüseyin Utku Özdeş1, Emre Ergen1, Okan Aslantürk1, Kadir Ertem1, Şeyma Yaşar3
1Department of Orthopedics and Traumatology, Turgut Özal Medical Center, İnönü University Faculty of Medicine, Malatya, Türkiye
2Department of Physical Therapy and Rehabilitation, Division of Rheumatology, Turgut Özal Medical Center, İnönü University Faculty of Medicine, Malatya, Türkiye
3Department of Biostatistics and Medical Informatics, İnönü University Faculty of Medicine, Malatya, Türkiye
Keywords: Capillaroscopy, cold intolerance, digit, nailfold, replantation, revascularization.
Abstract
Objectives: In this study, we aimed to evaluate microvascular changes using nailfold capillaroscopy in patients who underwent digit replantation and revascularization.
Patients and methods: A total of 46 patients (34 males, 12 females; mean age: 45.8±17.6 years; range, 18 to 75 years) who underwent replantation or revascularization procedures between February 2012 and May 2023 were retrospectively analyzed. Nailfold capillaroscopy images were assessed for various parameters including capillary count, diameter, dilatation, presence of giant capillaries, capillary disarrangement, microhemorrhages, neoangiogenesis, subpapillary plexus appearance, crossing capillaries, tortuosity, and microaneurysm. We investigated the association between microvascular alterations and clinical outcomes.
Results: Of 46 patients, 25 patients underwent replantation and 21 patients underwent revascularization. Significant microvascular changes, including subpapillary venous plexus, microvascular enlargement, microhemorrhages, neoangiogenesis, and tortuosity were observed in replantation patients (p=0.000b , p=0.020, p=0.021b , p=0.001, and p=0.004, respectively). However, these changes were not significant in revascularization patients. Revascularization patients exhibited an increase in capillary diameter and disarrangement (p=0.019 and p=0.016b , respectively). A significant negative correlation existed between digital nerve repairs and microvascular enlargement in replantation patients. Hyperesthesia was significantly correlated with neoangiogenesis and capillary disarrangement, while a statistically significant positive relationship was found between subpapillary venous plexus and patient satisfaction in replantation patients.
Conclusion: Our study showed that replantation patients who underwent two nerve repairs exhibited a well-regulated microvascular tone. However, we did not observe a statistically significant relationship between the number of nerve repairs and cold intolerance. Based on these findings, we highlight the potential of nailfold capillaroscopy in detecting microvascular changes following replantation and revascularization, which may contribute to a better understanding of the etiology of neurovascular complications.
Citation: Köroğlu M, Karakaplan M, Zontul S, Acet Ö, Özdeş HU, Ergen E, et al. Use of nailfold capillaroscopy for the assessment of patients undergoing digit replantation and revascularization. Jt Dis Relat Surg 2025;36(1):65-77. doi: 10.52312/jdrs.2024.1900.
Idea/concept, control/supervision: M.K., E.E, O.A., M.K.; Data collection: S.Z., Ş.Y., Ö.A.; Literature review: M.K., M.K., E.E., H.U.Ö., Ö.A.; Writing the article: M.K., M.K., E.E., S.Z., H.U.Ö., O.A.; Critical review: M.K., E.E., O.A., K.E.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.