Department of Anaesthesiology, A. J. Institute of Medical Sciences, Mangalore, Karnataka, India.
J Reconstr Microsurg. 2013 Mar;29(3):165-72. doi: 10.1055/s-0032-1331143. Epub 2013 Jan 25.
Early revascularization is cardinal for successful replantation of proximal limb amputations. Prolonged ischemia time potentially leads to reperfusion syndrome and morbidity. The dilemma persists regarding safe duration of cold ischemia time for replantation. The study was conducted to evaluate retrospectively the outcomes of major replantation in terms of limb survival, reperfusion events, morbidity, and potential mortality with respect to the ischemia time and level of amputations. Fourteen patients with proximal amputations at the arm, elbow, and forearm with total ischemia time beyond 6 hours were replanted. All had warm ischemia time of less than 2 hours and were closely monitored to record and correct reperfusion events. Nine out of 14 limbs survived. Five patients had reperfusion events. Proximal limb amputations with larger muscle mass were at higher risk of developing reperfusion syndrome and such events had higher chances of limb loss. Major limb amputations within 2 hours of warm ischemia time even with prolonged cold ischemia can be successfully replanted with closed perioperative monitoring.
早期血运重建对于成功进行肢体近段离断再植至关重要。长时间的缺血可能导致再灌注综合征和发病率。对于再植的安全冷缺血时间，仍存在争议。本研究回顾性评估了肢体存活率、再灌注事件、发病率以及与缺血时间和截肢水平相关的潜在死亡率，以此来评估主要再植的结果。对 14 例臂、肘和前臂近端离断伤患者进行再植，总缺血时间超过 6 小时。所有患者的热缺血时间均小于 2 小时，并密切监测以记录和纠正再灌注事件。14 个肢体中有 9 个存活。5 例患者发生再灌注事件。具有更大肌肉量的近端肢体离断伤发生再灌注综合征的风险更高，此类事件发生肢体丧失的几率也更高。即使冷缺血时间延长，2 小时内的主要肢体离断伤也可以在密切的围手术期监测下成功再植。
