The 4th congress of Asian Pacific Federation of societies for reconstructive microsurgery, Antalya, Turkey, 9 - 13 May 2018, pp.330-332
AN IMPERIOUS RESULT OF ISCHEMIA REPERFUSION INJURY: CASE REPORT
Emrah Kagan Yasar, Aykut Gök, Mehdi Asadov, Murat Şahin Alagoz
Department of Plastic, Reconstructive and Aesthetic Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
ıntroduction Ischemia reperfusion (IR) injury is a devastating situation which especially causes by prolonged warm ischemia.
The process between injury and replantation timing is very important for success. IR is inevitable out of delayed transfer to
medical center or prolonged replantation timing.
CASE: 45 years old woman was consulted with transmetacarpal left hand total amputation caused by a sharp blade injury
while working for 7 hours before. Physical examination shows no other signs or symptoms about other systems, and no any
drug usage was informed.
Patient and amputated part of the hand have been sent to operation room immediately after the end of preoperative workup.
FINDINGS: Amputation was at medial metacarpal level and dorsal oblique, Amputatta had no extra fractures. Proximal
and distal common digital arteries and nerves were placed in the operation and dorsal venules were marked. A total
of 3 arteries, 4 veins anastomosis, and 5 nerves coaptation were performed after bone fixation with kischner wires.
Repair of the flexor and extensor tendons was left for the next session. Despite the venous appearance in the early
postoperative period in the amputate dorsum, the rest of the amputate generally had normal capillarity and bright
appearance. After the control of the circulation, the operation was terminated and the patient was clinically followed
up by medical treatment. Until the 4th day postoperatively, there were no problems except the minimal bleeding from
the wound lips and the ischemic part of the dorsum. On the 5th day amputat was seen refilling the capillary fast. On the
6th day the amount of bleeding from the wound lips increased and exfoliation and bullae began to appear on the skin.
Necrosis began to sit on the amputate dorsum. Reexploration was not considered for the patient who was evaluated as
ischemia reperfusion injury. On day 8, there was a necrotic appearance in volcano and the replated tissue was evaluated
as total necrosis on the 9th day. The necrotic tissue was amputated and the tissue defect was repaired by inguinal flap.
RESULT: Ischemia reperfusion injury is a pathological condition that is mentioned very often but not frequently. Rapid
transfer and fast surgical ischemia are the measures to minimize the damage of reperfusio.. Especially the length of the
warm ischemia and the approach of the amputation level to the proximal can make the risk of ischemia reperfusion injury
Keywords: Ischemia reperfusion injury, warm ischemia, replantation