Intraoperative ischemia-reperfusion injury leading to re-amputation of the arm. Case report

IntroductionIschemia–reperfusion injury is an important mechanism of tissue damage characterized by inflammation and oxidative stress, occurring as a result of the temporary interruption of blood flow followed by its restoration. This case describes ischemia-reperfusion syndrome developing during replantation of an arm following traumatic amputation. Case ReportA 38-year-old male patient presented with traumatic amputation of the right arm at the distal humerus level following a machine-related injury, and developed severe hypotension and bradycardia due to systemic reperfusion injury during attempted replantation. Severe hemodynamic instability occurred. Vasopressor support and pharmacologic interventions were initiated; however, hemodynamic instability persisted. This led to an unanticipated intensive care unit admission. It was decided to re-amputate the arm because of the development of the reperfusion syndrome. With appropriate medical management, his clinical status improved, and he was successfully extubated and discharged without permanent complications.ConclusionSerious life-threatening complications may develop due to ischemia-reperfusion syndrome. Hence, timely management of intraoperative complications is vital in terms of mortality and morbidity.REFERENCES1.Zimmerman BJ, Granger DN. Reperfusion injury. Surg Clin North Am 1992; 72: 65-83.2.Eltzschig HK, Eckle T. Ischemia and reperfusion--from mechanism to translation. Nat Med. 2011;17(11):1391-1401.3.Omoke NI, Chukwu CO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. Int Orthop. 2012;36(3):613-618.4.Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. European Journal of Internal Medicine. 2008;19(8):568-574.5.Szijártó A, Turóczi Z, Szabó J, Kaliszky P, Gyurkovics E, Arányi P, et al. Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb. Cardiovasc Pathol. 2013;22(6):493-500.6.McCutcheon C, Hennessy B. Systemic reperfusion injury during arm replantation requiring intraoperative amputation. Anaesth Intensive Care. 2002;30(1):71-3.7.Hales P, Pullen D. Hypotension and bleeding diathesis following attempted arm replantation. Anaesth Intensive Care. 1982;10(4):359-61.