Replantation aims to restore the amputated part to its anatomical site, preserving function and appearance. Outcome depends on factors intrinsic to the patient and to the nature of the injury. Young patients who have distal, cleanly amputated extremities have the best return of function; multiple levels of injury, crush, or avulsing injuries have less. Patients must be fully informed about the commitment to rehabilitation and the possibility of multiple surgeries needed for best results. Similarly, patient and surgeon expectations should be evaluated and addressed before replantation. Meticulous microsurgical technique, comprehensive occupational therapy, and perseverance are needed for success. Addressing these issues promotes a team rehabilitation to restore function while getting the amputation patient back to productive position in society.
Ischemia-reperfusion (I/R) injury is, in part, related to the burst of reactive oxygen species (ROS) generated after reperfusion. Vitamin E has been shown to exert its biological effects as an antioxidant, inhibiting the ROS. In this report, the effect of Vitamin E succinate (VES) on ischemia/reperfusion injury and NF-κB expression was studied in a rat skeletal muscle model during reperfusion following a 4-h ischemic period. The study group consisted of muscle flaps infused with 150 mg/kg of VES given intraperitoneally 1 h post-initiation of ischemia. Muscle viability based on nitroblue tetrazolium staining, edema, and Doppler blood flow was measured in a control and a study group. Muscle samples were analyzed by standard gel shift assay. The VES experimental group showed an increase in muscle viability compared to controls (average of 44.675% versus 31.925%, respectively, p=0.0415). Blood flow, measured by Doppler 24 h after reperfusion, was increased in the VES study group compared to controls (10.3 vs. 5.1 ml/g/s p=0.00355). Additionally, the VES group showed a trend of decreasing edema compared with the control; however, not at a level that was statistically significant (p=0.1267). The VES-treated group showed a decreased expression of NF-κB as compared to controls (p<0.05). These results show that vitamin E succinate has a protective effect in preventing I/R injury as measured by increased muscle viability and reperfusion blood flow. Vitamin E can exert its efforts as an antioxidant as well as other biological roles, including inhibition of NF-κB.
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