Hypertonic saline reduces skeletal muscle injury and associated remote organ injury following ischemia reperfusion injury

Dillon, John P; Laing, Alan J.; Chandler, John; Shields, Conor; Wang, Juan H.; McGuinness, A.; Redmond, H. P.

doi:10.1080/17453670810016740

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Many medical treatment options such as recombinant human BCL2 protein, ethyl pyruvate, laser therapy, hydrogen sulfide, PJ 34, poloxamer 188, ketamine, recombinant human VEGF165 protein, activated protein C, adenosine A, bortezomib, MRS2693, hypertonic saline solution, cariporide, grape seed proanthocyanin extract, Wisconsin solution, ultrasound, erythropoietin, resveratrol, vitamin E, 12 amino acid peptides have been experimentally studied and all of them were reported to have positive effects at some degree. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] However, studies on all these agents remained experimental and these agents failed to find a place in clinical use.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ischemic Preconditioning and Systemic Piracetam for Prevention of Ischemia-Reperfusion Injury in Musculocutaneous Flaps

Demiröz

Derebaşınlıoğlu

Ercan

et al. 2020

J Reconstr Microsurg

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Background Ischemia-reperfusion injury plays an important role in flap failure. Ischemic preconditioning technique is the only proven method for preventing ischemia-reperfusion injury, but it is not used widely in daily practice because of difficulties such as prolonging the operation time, need for surgical experience, and increasing the risk of complications. This study has been performed with the assumption that piracetam may be a simple and inexpensive alternative to the preconditioning technique due to its antioxidant, antiaggregant, rheological, anti-inflammatory, antiapoptotic, cytoprotective, and immune modulating effects. Methods Thirty-two rats were divided into four groups and latissimus dorsi musculocutaneous flaps were raised. No extra procedure was applied, and no treatment was given to the control group. Four hours of ischemia was created by clamping the thoracodorsal pedicle in the second group. The animals in the third group were treated with 10 minutes of ischemia and reperfusion periods as a preconditioning procedure before the 4 hours of ischemia. Animals in the fourth group received systemic piracetam 30 minutes before and 6 days after reperfusion. Nitric oxide and myeloperoxidase levels in serum and tissue, acute inflammatory cell response, and vascular proliferation in tissue were examined at the postoperative 24th hour and 10th day. Results Myeloperoxidase activity in both preconditioning and piracetam groups, was significantly lower than the ischemia-reperfusion group. Acute inflammatory cell response was similarly decreased in both preconditioning and piracetam groups compared with ischemia-reperfusion group. Tissue measurements of nitric oxide were also significantly higher in both preconditioning and piracetam groups than in the ischemia-reperfusion group. However, vascular proliferation increased in the preconditioning group, while it did not show any significant change in the piracetam group. Conclusion This study shows that systemic piracetam treatment provides protection against ischemia-reperfusion injury in musculocutaneous flaps and can offer a simple and inexpensive alternative to the preconditioning technique.

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Section: Discussionmentioning

confidence: 99%

Comparison of Ischemic Preconditioning and Systemic Piracetam for Prevention of Ischemia-Reperfusion Injury in Musculocutaneous Flaps

Demiröz

Derebaşınlıoğlu

Ercan

et al. 2020

J Reconstr Microsurg

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“… illustrated the fasciotomy reduction during pressure injury; Dillon et al . showed the effectiveness of the hypertonic saline solution on inflammatory response; Cowled et al . and Chello et al .…”

Section: Discussionmentioning

confidence: 99%

Fatal early peripheral post‐reperfusion syndrome and the role of cutaneous signs

Serra

Ciranni

Molinari

et al. 2014

International Wound Journal

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The purpose of this report is to present the case of a 75-year-old male affected by right common femoral artery and abdominal aortic aneurysms. His clinical history was also characterised by post-ischaemic cardiomyopathy, arterial hypertension, chronic respiratory disease and peripheral arterial disease. We performed two surgical procedures: right femoral aneurysmectomy and femoro-femoral bypass and subsequently a femoro-femoral crossover bypass plus right femoro-popliteal bypass below the knee. The second operation became necessary in order to treat acute occlusion of the right iliac-femoral arterial axis. The patient developed a progressive and aggressive lower limb post-perfusion syndrome associated to frank peripheral oedema, myocardial stunning, reperfusion arrhythmias, renal failure and respiratory distress. Cutaneous alterations (oedema of the leg, mottled skin and cyanosis of the foot) were more specific compared with Doppler ultrasound that showed the presence of adequate blood flow in the early phase. On the basis of this experience and of pertinent literature, this study represents a challenge for the understanding of the exact mechanism of origin and progression of post-reperfusion syndrome.

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“…Attuwaybi et al 57 showed that the use of hypertonic saline prevented inflammation and injury, and impaired gut transit after intestinal ischaemia and reperfusion by inducing the enzyme haem oxygenase 1. In an experimental model of limb ischaemia-reperfusion, rats treated with hypertonic saline before tourniquet release had a significant decrease in myeloperoxidase content, less skeletal muscle oedema and an improvement in the functional properties of the skeletal muscle 9 . These and other studies demonstrate that hypertonic saline has the potential to reduce the adverse effects of reperfusion following extremity vascular injury with ischaemia.…”

Section: Hypertonic Salinementioning

confidence: 99%

Reperfusion strategies in the management of extremity vascular injury with ischaemia

Percival

Rasmussen

2011

British Journal of Surgery

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Background: Extremity injury with ischaemia is the most common pattern of vascular trauma and is a challenge for surgeons who must make decisions about the timing and mechanism of limb reperfusion. In modern military conflicts, effective use of limb tourniquets and rapid transport of the injured have increased the number of casualties who reach a medical service with potentially survivable vascular trauma. This report provides a review of extremity ischaemia and reperfusion following vascular trauma.Methods: A review was undertaken of extremity vascular injury with ischaemia, including a focus on adjuncts aimed at reducing reperfusion injury and improving neuromuscular recovery and limb salvage.Results: Findings from basic and clinical research support the need to restore perfusion to an ischaemic limb as soon as possible in order to achieve optimal neuromuscular recovery. Large-animal studies demonstrate that haemorrhagic shock worsens the impact of ischaemia on the neuromuscular structures of the limb and reduces the ischaemic threshold to as little as 1 h. Surgical adjuncts such as vascular shunts, fasciotomy, regional limb cooling and ischaemic conditioning may reduce the severity of ischaemic injury. Medical therapies have also been described including hypertonic saline, statins and ethyl pyruvate, which reduce the inflammatory response following limb reperfusion. Conclusion:Contemporary translational research refutes a casual approach to extremity vascular injury with ischaemia, instead emphasizing expedited reperfusion. Surgical and medical adjuncts exist to expedite reperfusion and mitigate reperfusion injury. Additional research and development of these adjuncts is necessary to improve quality or functional limb salvage after vascular trauma.

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Hypertonic saline reduces skeletal muscle injury and associated remote organ injury following ischemia reperfusion injury

Abstract: Treatment with hypertonic saline attenuates skeletal muscle ischemia reperfusion injury and its associated systemic sequelae.

Cited by 7 publications

References 18 publications

Comparison of Ischemic Preconditioning and Systemic Piracetam for Prevention of Ischemia-Reperfusion Injury in Musculocutaneous Flaps

Comparison of Ischemic Preconditioning and Systemic Piracetam for Prevention of Ischemia-Reperfusion Injury in Musculocutaneous Flaps

Fatal early peripheral post‐reperfusion syndrome and the role of cutaneous signs

Reperfusion strategies in the management of extremity vascular injury with ischaemia

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