Upper limb replantation: surgical strategy and the prophylaxis of acute renal failure due to ischemia reperfusion injury – A report of two cases

Predrag Kovačević; Jefta Kozarski; Dragana Djordjević; Irena Janković; Dimitrije Pavlović

doi:10.2298/VSP200906120K

Predrag Kovačević University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia
Jefta Kozarski Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia; University of Defence Belgrade, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Dragana Djordjević University Clinical Center of Niš, Anesthesia and Intensive Care Clinic, Niš, Serbia
Irena Janković University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia
Dimitrije Pavlović University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia

DOI: https://doi.org/10.2298/VSP200906120K

Keywords: hand;, intensive care units;, reconstructive surgical procedures;, replantation;, respiration, artificial.

Abstract

Introduction. The arm replantation is an extremely rare and challenging procedure. The recognized risk is myoglobinuria and, consenquently, ischemia reperfusion-induced renal failure. Case report. We presented two patients aged 24 and 46 years who were admitted after traumatic arm amputation. Ischemia time was six and two hours, respectively. Postoperative intensive care treatment with assisted ventilation, sedation, and obtaining sufficient urine output prevented myoglobin-induced renal injury. In the case where ischemia time was shorter, there was only one delayed reconstruction of skin defects after fasciotomy, but in the case where ischemia lasted longer, the patient had two secondary look procedures with acceptable definitive results. Conclusion. Arm replantation is a safe procedure even in cases with longer ischemia time. Postoperative control of urine output, correction of acidosis, and preventing myoglobin-induced tubular injury are crucial for stable postoperative recovery and.

Author Biographies

Predrag Kovačević, University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia

MD, DMD, PhD

Jefta Kozarski, Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia; University of Defence Belgrade, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

MD, PhD

Dragana Djordjević, University Clinical Center of Niš, Anesthesia and Intensive Care Clinic, Niš, Serbia

MD

Irena Janković, University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia

MD, PhD

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