Treatment of "Toxemia" After Extremity Replantation

Mehl, Roger L.; Paul, Harold; Shorey, William D.; Schneewind, John H.; Beattie, Edward J.

doi:10.1001/archsurg.1964.01320050117010

Cited by 25 publications

(6 citation statements)

References 10 publications

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“…There are some ischemia-reperfusion models in lower extremities, such as ligation of all arteries distal to the renal artery [10], amputation leaving the femoral artery and vein intact [11], and ligation of the femoral artery and two-thirds femoral muscles divided [12]. However, in these models, uniform ischemia was not induced due to individual differences regarding collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ischemic Damage in the Skeletal Muscle with the Use of Electrical Properties

Hayashi

Sasaki

Senga

et al. 1998

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Evaluation of Ischemic Damage in the Skeletal Muscle with the Use of Electrical Properties

Hayashi

Sasaki

Senga

et al. 1998

Journal of Surgical Research

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“…7,8 Sudden acidosis has also been described after reimplantation of limbs. 10 It is highly likely that some of the earlier attempts at orthotopic transplantation would have succeeded had there not been the development of pulmonary emboli. It is tragic to realize now that the external bypasses, which undoubtedly contributed to the complication in those cases, 21,22,26 were probably unnecessary, since all the earlier patients had extensive venous collaterals secondary to their liver disease.…”

Section: Discussionmentioning

confidence: 99%

Extended survival in 3 cases of orthotopic homotransplantation of the human liver

Starzl¹,

Groth²,

Brettschneider³

et al. 1968

Transplantation

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There have been 9 reported attempts of orthotopic homotransplantation of the human liver-7 in Denver 16,21,22 and one each in Boston 11 and Paris. 5 Survival time was 0 to 23 days. There were multiple reasons for death in each case, but in most an important factor was either the failure to obtain good immediate liver function or the inability to subsequently maintain such function.On July 23 and 31, Sept. 5, and Oct. 8, 1967, 4 more orthotopic liver transplantations were performed in our institutions. The recipients are at the time of this writing 94, 86, 49, and 14 days postoperative. This report is concerned with the first 3 of these patients and with the improvements in therapy which were brought to these cases. In addition, attention will be directed to a number of serious and previously unrecognized problems which were encountered. The diagnosis and treatment of these complications will be presented, as well as some thoughts about how they might be prevented in future cases. OBSERVATIONS Case materialThe 3 recipients (hereafter called Patients 1 to 3) were 19, 20½, and 13 months old and weighed 10.8, 8.7, and 9.4 kilograms. All were girls. The diagnosis of nonresectable hepatic-cell carcinoma was made in Patient 1 at an abdominal exploration when she was 13 months old. During the next 5 months, the tumor had grown inexorably despite liver irradiation with a total of 975 r and systemic therapy with actinomycin-D, cyclophosphamide, methotrexate, and 5-fluorouracil. Liver function was normal. ADDENDUMTwo of the 3 patients in this series are still alive as of January 27, 1968. Patient 1 has now survived for more than 6 months. Liver function remains excellent, but she has developed slow-growing pulmonary metastases. Patient 3 will be 5 months postoperative in 1 week. Patient 2, who had poor liver function at the time the report was submitted, died after 134 days. The immediate cause of death was massive intestinal gangrene. Two more infants with biliary atresia have received orthotopic homotransplantation. The first died 61 days after transplantation as a consequence of thrombosis of the right hepatic artery and gangrene of the liver lobe. The second child is more than 2 months postoperative and has not had any of the complications described in the text. Drs. Pierre Daloze of Montreal and Claude Huguet of Paris were important members of the operating teams. Drs. Anthony Aldrete, Theodore Gingrich, and David LeVine provided the anesthesia. Three medical students made important contributions to the postoperative care of the patients; The homograft donorsThe donors for Patients 1 to 3 were 18 months, 4 years, and 18 months old and weighed 6.4, 13.0, and 8.2 kilograms. The first was a boy and the second and third were girls. The red-cell types of the 3 donors were the same as those of the recipients, namely O, O, and A.The condition of the donors was hopeless at the time of admission to the hospital because of brain damage and apnea. One was a microcephalic who had been resuscitated from a postaspiration cardiac ...

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“…Diagnosis can be confirmed Restoration of the arterial circulation must be achieved within the ischemia tolerance time, which means about 4 to 6 hours for an extremity [1,[15][16][17] and less for the viscera. Revascularization beyond that time enhances the injury by a tourniquet syndrome [18]. Delayed revascularization may also be followed by an extensive edema of muscle which should be relieved by immediate fasciotomy.…”

Section: Indirect Traumamentioning

confidence: 99%

“…Artificial cooling to reduce tissue metabolism may cause constriction of the peripheral vascular bed and reduction of collateral blood flow and, therefore, lead to extensive necrosis. On the other hand, it may be justified to reduce pain and to minimize resorption of toxic metabolites [18] in cases of impending amputation.…”

Section: Indirect Traumamentioning

confidence: 99%

Vascular injuries in polytrauma

et al. 1983

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In our surgical clinic, from January 1, 1978, to May 15, 1982, a total of 41 patients with polytrauma exhibited 45 concomitant vascular injuries requiring operation. This group of patients represents 10% of the 407 multiple trauma patients treated during this period. The incidence of vascular lesions of shoulder, neck, and upper extremities was 2.7% (n=11); lower extremities, 4.7% (n=19); within the abdominal cavity, 1% (n=4); and of acute thoracic aortic rupture, 2.7% (n=11). Seven patients (17%) died: 4 from additional brain trauma, 3 from hemorrhage by aortic ruptures. There were 6 major amputations (2 primary, 4 secondary) and 2 borderline amputations. In the remaining 26 patients, a good result following vascular repair was achieved. Angiologic examination, including computed tomography and angiography, is of great importance. Vascular repair deserves high priority since bleeding and/or ischemia threatens the patient's limbs, organs, or even life. This is especially true for the acute thoracic aortic rupture as a typical vascular injury in polytrauma. The incidence of peripheral vascular injuries in polytrauma is twice as high (7.3%) as in isolated extremity fractures (3.6%).

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Treatment of "Toxemia" After Extremity Replantation

Cited by 25 publications

References 10 publications

Evaluation of Ischemic Damage in the Skeletal Muscle with the Use of Electrical Properties

Evaluation of Ischemic Damage in the Skeletal Muscle with the Use of Electrical Properties

Extended survival in 3 cases of orthotopic homotransplantation of the human liver

Vascular injuries in polytrauma

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