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. 2023 Dec 18;31(6):e267476.
doi: 10.1590/1413-785220233105e267476. eCollection 2023.

CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION?

Raquel Bernardelli Iamaguchi  1 , Guilherme Moreira Dias  1 , Fernanda DO Carmo Iwase  1 , Marcelo Rosa DE Rezende  1 , Rames Mattar  1
Affiliations

CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION?

Raquel Bernardelli Iamaguchi et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries.

Objective: To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results.

Methods: A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021.

Results: In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours).

Conclusion: Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.

Observa-se um atraso no referenciamento dos casos para o tratamento definitivo das amputações traumáticas de membros no Brasil. Casos com amputações proximais ao punho apresentam um prazo limite para reimplante, sendo lesões que promovem risco de vida ao paciente.

Objetivo: Analisar os macrorreimplantes com tempo de isquemia prolongado submetidos à cateterização temporária da artéria, para determinar a viabilidade do coto de amputação, e seus resultados.

Métodos: Série de casos de todos os pacientes com amputações traumáticas proximais ao punho, cujo tempo de isquemia fria foi igual ou superior a seis horas, entre 2017 e 2021.

Resultados: A amostra foi composta por oito pacientes com amputações traumáticas de antebraço operados por dois cirurgiões. O tempo médio de isquemia foi de oito horas. Todos os pacientes necessitaram de cirurgias adicionais, sendo as mais comuns o enxerto de pele ou a revisão da fixação óssea. Sucesso do macrorreimplante foi observado em cinco pacientes. O tempo médio de isquemia fria foi maior no grupo com sucesso no macrorreimplante (7,4 horas) quando comparado com o grupo sem sucesso (9 horas).

Conclusão: Os macrorreimplantes necessitam de transferência imediata para serviços especializados, e, apesar de a cateterização temporária arterial auxiliar no manejo cirúrgico, a técnica parece não interferir nos resultados. Nível de Evidência IV, Série de Casos.

Keywords: Amputation; Catheterization; Extremities; Forearm; Microsurgery; Wounds and Injury.

PubMed Disclaimer

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Case 6: (A, B) X-ray of the amputated limb on arrival at the hospital; (C) Radiography after three months of reimplantation showing no bone consolidation; (D) Image after eight years of surgery and a synthesis revision with good consolidation; (E) Clinical image of the limb after eight years.
Figure 2
Figure 2. Distribution by amputation level.
Figure 3
Figure 3. Case 5: (A) Postoperative radiography with synthesis with plate and screws; (B, C) X-ray after nine years of surgery, showing bone healing; (D, E, F, G) Clinical images of the upper limb after nine years.
Figure 4
Figure 4. Case 2: (A, B, and C) Upper limb and amputated forearm; (D and E) Intraoperative images; (F and G) Appearance after one week of surgery; (H) Forearm X-ray after conversion for synthesis with a screw plate; (I) Aspect of the upper limb at follow-up.
Figure 5
Figure 5. Case 4: (A and B) X-rays of the wrist and amputated hand; (C) Appearance of the hand amputated by avulsion; (D) Debridement of non-viable tissue; (E and F) Final appearance after surgery; (G and H) Radioscopy imaging after wrist arthrodesis; (I) Image after skin graft surgery showing good integration; (J) Clinical image of the upper limb at follow-up; and (K) Patient holding an object.
Figure 6
Figure 6. Case 7: Clinical case with the longest cold ischemic time (10 hours). This female patient was hit by a train, which traumatically amputated her right forearm. The case evolved to worsened perfusion four days after macro-reimplantation and the patient chose amputation and regularization of her right upper limb.
Figure 7
Figure 7. Case 3: (A and B) Upper limb and amputated forearm; (C and D) Radiographs of the upper limb (showing an ipsilateral fracture of the humerus) and amputated forearm; (E) Intraoperative imaging with isolated vessels; (F) Final surgery image; (G) Postoperative X-ray with humerus, radius, and ulna synthesis; (H) Evolution with necrosis of the skin and of the soft portions of the anterior forearm; (I) post-surgery image of the anterolateral flap of the thigh for forearm coverage; (J) Final image of the upper limb; and (K) Evidence of function for activities of daily living.
See this image and copyright information in PMC

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