Intraoperative ischemia-reperfusion injury leading to re-amputation of the arm. Case report

Öz

Introduction Ischemia–reperfusion injury is an important mechanism of tissue damage characterized by inflammation and oxidative stress, occurring as a result of the temporary interruption of blood flow followed by its restoration. This case describes ischemia-reperfusion syndrome developing during replantation of an arm following traumatic amputation. Case Report A 38-year-old male patient presented with traumatic amputation of the right arm at the distal humerus level following a machine-related injury, and developed severe hypotension and bradycardia due to systemic reperfusion injury during attempted replantation. Severe hemodynamic instability occurred. Vasopressor support and pharmacologic interventions were initiated; however, hemodynamic instability persisted. This led to an unanticipated intensive care unit admission. It was decided to re-amputate the arm because of the development of the reperfusion syndrome. With appropriate medical management, his clinical status improved, and he was successfully extubated and discharged without permanent complications. Conclusion Serious life-threatening complications may develop due to ischemia-reperfusion syndrome. Hence, timely management of intraoperative complications is vital in terms of mortality and morbidity. REFERENCES 1. Zimmerman BJ, Granger DN. Reperfusion injury. Surg Clin North Am 1992; 72: 65-83. 2. Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011;17(11):1391-1401. 3. Omoke NI, Chukwu CO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. Int Orthop. 2012;36(3):613-618. 4. Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. European Journal of Internal Medicine. 2008;19(8):568-574. 5. Szijártó A, Turóczi Z, Szabó J, Kaliszky P, Gyurkovics E, Arányi P, et al. Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb. Cardiovasc Pathol. 2013;22(6):493-500. 6. McCutcheon C, Hennessy B. Systemic reperfusion injury during arm replantation requiring intraoperative amputation. Anaesth Intensive Care. 2002;30(1):71-3. 7. Hales P, Pullen D. Hypotension and bleeding diathesis following attempted arm replantation. Anaesth Intensive Care. 1982;10(4):359-61.

Anahtar Kelimeler

• Amputation
• Intensive care
• Replantation
• Reperfusion injury
• Shock
• Traumatic amputation

Kolun Re-Amputasyonu ile Sonuçlanan İntraoperatif İskemi-Reperfüzyon Hasarı: Olgu Sunumu

Öz

Giriş Bu olguda, travmatik amputasyon sonrası gerçekleştirilen kol replantasyonu sırasında gelişen iskemi-reperfüzyon sendromu sunulmaktadır. Olgu Sunumu Otuzlu yaşlarındaki bir hastada, iş kazası sonrası ampute olan kolun replantasyonu sırasında, sistemik reperfüzyon hasarına bağlı olarak ağır hipotansiyon ve bradikardi gelişmiştir. Süreçte şiddetli hemodinamik instabilite gözlenmiş ve yüksek doz inotropik destek ihtiyacı doğmuştur. Bu durum, öngörülemeyen bir yoğun bakım ünitesi yatışıyla sonuçlanmıştır. Reperfüzyon sendromunun gelişmesi nedeniyle kolun re-ampute edilmesine karar verilmiştir. Sonuç İskemi-reperfüzyon sendromuna bağlı olarak yaşamı tehdit eden ciddi komplikasyonlar gelişebilmektedir. Bu nedenle, intraoperatif komplikasyonların zamanında yönetilmesi, mortalite ve morbiditenin önlenmesi açısından hayati önem taşımaktadır. REFERENCES 1. Zimmerman BJ, Granger DN. Reperfusion injury. Surg Clin North Am 1992; 72: 65-83. 2. Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011;17(11):1391-1401. 3. Omoke NI, Chukwu CO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. Int Orthop. 2012;36(3):613-618. 4. Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. European Journal of Internal Medicine. 2008;19(8):568-574. 5. Szijártó A, Turóczi Z, Szabó J, Kaliszky P, Gyurkovics E, Arányi P, et al. Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb. Cardiovasc Pathol. 2013;22(6):493-500. 6. McCutcheon C, Hennessy B. Systemic reperfusion injury during arm replantation requiring intraoperative amputation. Anaesth Intensive Care. 2002;30(1):71-3. 7. Hales P, Pullen D. Hypotension and bleeding diathesis following attempted arm replantation. Anaesth Intensive Care. 1982;10(4):359-61.

Anahtar Kelimeler

• Amputasyon
• Yoğun bakım
• Replantasyon
• Reperfüzyon hasarı
• Travmatik amputasyon
• Şok

Kaynakça

1. 1. Zimmerman BJ, Granger DN. Reperfusion injury. Surg Clin North Am. 1992;72(1):65-83. doi:10.1016/s0039-6109(16) 45628-8
2. 2. Juricic S, Klac J, Stojkovic S, et al. Molecular and Cellular Mechanisms of Myocardial Ischemia and Reperfusion Injury: A Narrative Review. Cells. 2026;15(3):265. doi:10.3390/cells15030265
3. 3. Naito H, Nojima T, Fujisaki N, Tsukahara K, Yamamoto H, Yamada T, et al. Therapeutic strategies for ischemia reperfusion injury in emergency medicine. Acute Med Surg. 2020 Apr 13;7(1):e501. doi: 10.1002/ams2.501.
4. 4. Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011;17(11):1391-1401.
5. 5. Omoke NI, Chukwu CO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. Int Orthop. 2012;36(3):613-618.
6. 6. Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. European Journal of Internal Medicine. 2008;19(8):568-574.
7. 7. Szijártó A, Turóczi Z, Szabó J, Kaliszky P, Gyurkovics E, Arányi P, et al. Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb. Cardiovasc Pathol. 2013;22(6):493-500.
8. 8. McCutcheon C, Hennessy B. Systemic reperfusion injury during arm replantation requiring intraoperative amputation. Anaesth Intensive Care. 2002;30(1):71-3.