Temporary catheter first perfusion during hand replantation with prolonged warm ischaemia
2012 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, Vol. 65, no 5, 675-677 p.Article in journal (Refereed) Published
Introduction: Since the first successful arm replantation reported by Malt and McKhann in 1962, developments and refinements to upper extremity replantation techniques have led to higher success rates with better functional outcomes. One of the most important determinants of a successful macroreplantation is the ischaemic time of the amputated part, as irreversible muscle necrosis begins after 6 hours of warm ischaemia. With major trauma and plastic surgery units usually covering a wide geographical area, it is often difficult to ensure patient injury to revascularization time is less than 6 hours. In 1981, Nunley et al described the temporary catheter perfusion technique in upper limb replantation surgery to reduce ischaemia time without any significant complications. When used in appropriate cases this technique can reduce complication rates in upper limb replantation surgeries. Material and methods: Temporary catheter first perfusion was used in a hand replantation after 6 hours of warm ischaemia, with preservation of the intrinsic muscles, as evidenced by return of function. The technique used is described, along with relevant literature. Results: Temporary catheter perfusion allowed early reperfusion of the amputated hand, improving the chance of intrinsic muscle preservation despite delayed presentation. It allowed better wound evaluation and debridement, and facilitated better bone stabilisation prior to vascular repair. Conclusion: Temporary catheter perfusion is well described in proximal upper limb replantation procedures. This case shows that it is also a useful adjunct for hand replantation, particularly when the patient presents with a critical duration of warm ischaemia. (C) 2011 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Place, publisher, year, edition, pages
2012. Vol. 65, no 5, 675-677 p.
Hand replantation, Microsurgery, Catheter first perfusion, Warm ischaemia, Reperfusion injury, Major replantation
IdentifiersURN: urn:nbn:se:umu:diva-55306DOI: 10.1016/j.bjps.2011.09.006ISI: 000302864300029OAI: oai:DiVA.org:umu-55306DiVA: diva2:527315