Lactate Levels in a Replanted Limb as an Early Biomarker for Assessing Post-Surgical Evolution: A Case Report

Abstract

Background and Clinical Significance: In the clinical management of major pediatric traumatic injuries and other hypoxic conditions, lactate is widely recognized as a key indicator of tissue hypoxia and potential necrosis. However, its prognostic value remains uncertain. Several factors influence post-surgical outcomes, including the time between amputation and replantation, transport conditions, asepsis, the extent of tissue necrosis, hemorrhagic shock, coagulation disorders, and the heightened risk of contamination. Case presentation: We present this case to emphasize the utility of systemic lactate versus lactate levels in the replanted limb for monitoring post-transplantation outcomes in a pediatric patient with traumatic limb amputation. Significant fluctuations in lactate levels within the replanted limb were observed at the onset of unfavorable evolution, specifically on the seventh postoperative day, coinciding with the identification of Aspergillus spp. infection. This necessitated the use of synthetic saphenous vein grafts and Amphotericin B administration. Despite these interventions, disease progression ultimately led to limb amputation. Conclusions: Lactate levels in the replanted limb may serve as an early biomarker for assessing post-surgical evolution. However, further case reports are required to confirm its predictive value.

Keywords: lactate; limb replantation; pediatric trauma; postoperative prognosis.

Figure 1

(a) Comparative analysis of systemic lactate values; (b) lactate values in replanted limb.

Figure 1

(a) Comparative analysis of systemic lactate values; (b) lactate values in replanted limb.

Figure 2

Dynamic evaluation (hours) of systemic lactate and lactate in replanted limb.

Figure 3

High-magnification view of muscular tissue exhibiting areas of necrosis (yellow arrows), polymorphous inflammatory infiltration (red arrow), and hemorrhage (blue arrow). Stained with hematoxylin and eosin (H&E), scale bar 50 µm, 20× magnification of camera lens.

Figure 4

Inflammatory exudate (red arrows) with fungal elements (blue arrows), highlighted by Periodic Acid-Schiff (PAS) staining, scale bar 20 µm, 40× magnification of camera lens. In our patient, Aspergillus was present in wound, specifically around arteriovenous graft within anastomosis area, before insertion of synthetic graft. Following identification of Aspergillus spp., synthetic vascular graft was inserted to clean wound and disrupt fungal growth.