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

IF 0.5 4区 医学 Q4 ORTHOPEDICS Acta Ortopedica Brasileira Pub Date : 2023-12-18 eCollection Date: 2023-01-01 DOI:10.1590/1413-785220233105e267476
Raquel Bernardelli Iamaguchi, Guilherme Moreira Dias, Fernanda DO Carmo Iwase, Marcelo Rosa DE Rezende, Rames Mattar
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Abstract

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.

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临时动脉导管插入术能否延长大移植的缺血时间?
我们发现,外伤性肢体截肢患者被延迟转诊至适当的显微外科部门并接受明确治疗。腕部近端截肢的病例有手术再植的最后期限,因为这些配置会危及生命:分析接受临时动脉导管插入术的腕部近端上肢创伤性截肢且缺血时间较长的患者,以评估残端存活能力和结果:病例系列研究,包括2017年至2021年所有腕部上肢近端截肢且冷缺血时间等于或超过6小时的患者:共有两名外科医生为8名经历过前臂截肢损伤的患者实施了手术。中位缺血时间共计8小时。所有患者都需要进行额外手术,最常见的是裂厚植皮或固定翻修(3 名患者)。这项研究成功完成了五例大再植手术。成功大再植组的平均冷缺血时间(7.4 小时)长于失败组(9 小时):结论:大再植需要立即转入显微外科手术,虽然临时动脉导管检查有助于手术决策,但该技术似乎无法影响手术结果。证据等级 IV,回顾性病例系列。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
67
审稿时长
25 weeks
期刊介绍: A Revista Acta Ortopédica Brasileira, órgão oficial do Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo (DOT/FMUSP), é publicada bimestralmente em seis edições ao ano (jan/fev, mar/abr, maio/jun, jul/ago, set/out e nov/dez) com versão em inglês disponível nos principais indexadores nacionais e internacionais e instituições de ensino do Brasil. Sendo hoje reconhecidamente uma importante contribuição para os especialistas da área com sua seriedade e árduo trabalho para as indexações já conquistadas.
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