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

• Published in: Acta ortopedica brasileira 2023-01, Vol.31 (6), p.e267476-e267476
• Main Authors: Iamaguchi, Raquel Bernardelli, Dias, Guilherme Moreira, Iwase, Fernanda DO Carmo, Rezende, Marcelo Rosa DE, Mattar, Rames
• Format: Article
• Language: English
• Subjects: Amputation; Catheterization; Extremities; Forearm; Microsurgery; Original; ORTHOPEDICS; Wounds and Injury
• ISSN: 1413-7852; 1809-4406; 1809-4406
• DOI: 10.1590/1413-785220233105E267476

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. 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. 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. 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). Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes.