Replantation of Amputated Extremities

Successful Replantation of the Lower Leg after 42-Hour Ischemia: Case Report

“…None of the previous researchers managed to avoid the death of large numbers of experimental animals-up to 40 or more percent in some cases. '- 4 As has been noted by researchers, animal mortality after surgery increased with the lengthening of the periods of interrupted circulation in the extremities. 56 This encouraged investigators to search for the cause of animal death in factors associated with tissue ischemia.…”

Limb preservation for reimplantation. A review

“…In one study, the cooling of the sciatic nerves of cats to + 3 to -4°C for 2 hours produced degeneration of the largest medullated fibers in specimens examined 3 days later, possibly as a result of a chemical change of the fats of myelinPo Physiologic changes in the legs of rats after they had been cooled also suggested nerve injury:' Connective tissue is less susceptible to ischemia, and skin also tolerates it we11. 39,42 The impact of warm ischemia on severed parts is well known, and attempts at the reimplantation of limbs kept at room temperature for more than 6 to 8 hours are remarkably unsuccessful P3, 44 Nontechnical problems include limb edema, acidosis, and myoglobinuria. 45 In the limbs of monkeys made ischemic with tourniquets, tissue PO, dropped rapidly in 15-30 minutes, indicating continued metabolism and the rapid use of existing oxygen Cooling the limbs of dogs to 2°C during tourniquet occlusion for 5 hours prevented the death of dogs that would have died if the limbs were left at room temperature, although the reasons for this are not clearP5 A study on "replantation toxemia" in dogs demonstrated a continuation of metabolism in the transected part with lactic acidosis (anaerobic metabolism).…”