Quantitative Studies on the Time Factor in Arterial Injuries

H, Miller; Welch, C. Stuart

doi:10.1097/00000658-194909000-00010

Cited by 133 publications

(32 citation statements)

References 3 publications

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“…Skeletal muscular tissue is particularly resistant to lesions, being able to bear long periods of ischaemia (Miller & Welch 1949; Hughes 1957; Thompsom et al. 1970; Blaisdell et al.…”

mentioning

confidence: 99%

Ischaemia and reperfusion effects on skeletal muscle tissue: morphological and histochemical studies

Carmo-Araujo

Dal-Pai-Silva

Dal-Pai

et al. 2007

Int J Experimental Path

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This was a study on the oxidative stress due to ischaemia (I) and reperfusion (R) in skeletal muscle tissue. Using a tourniquet, groups of rats were submitted to ischaemia for 4 h, followed by different reperfusion periods. The animals were divided in four groups: control; 4 h of ischaemia (IR); 4 h of ischaemia plus 1 h reperfusion (IR-1 h); 4 h of ischaemia plus 24 h reperfusion (IR-24 h); and 4 h of ischaemia plus 72 h reperfusion (IR-72 h). At the end of the procedures, samples of soleus muscle were collected and frozen in n-hexane at -70 degrees C. Cryostat sections were submitted to haematoxylin-eosin, succinate dehydrogenase (SDH) and nicotinamide adenine dinucleotide-tetrazolium reductase (NADH-TR) stains. An additional muscle sample was processed for electron microscopy. No alterations were found in control animals. IR group showed fibres had normal aspect besides some round, acidophilic and hypertrophic fibres. There were several fibres with angular outlines and smaller diameters in this group compared with control group. NADH-TR/SDH reaction was moderately intense in most fibres. In some fibres, cytoplasm showed areas without activity and other fibres had very intense reactivity. IR-1 h group showed oedema hypercontracted fibres with disorganized myofibrils, mitochondria with focal lesions and dilated sarcoplasmic reticulum. NADH-TR/SDH reaction was moderate to weak. IR-24 h showed intense inflammatory infiltrate in the endomysium and perimysium. NADH-TR/SDH reaction was similar to IR-1 h. IR-72 h showed necrotic fibres, areas with inflammatory infiltrate, reduced muscle fibres at different stages of necrosis and phagocytosis, and many small round and basophilic fibres characterizing a regeneration process. NADH-TR/SDH reaction was weak to negative. Our results suggest that ischaemia and the subsequent 1-, 24- and 72-h reperfusions induced progressive histological damage. Although progressive, it may be reversible because there were ultrastructural signs of recovery after 72-h reperfusion. This recovery could in part be due to the low oxidative stress identified by the morphological and histochemical analysis.

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“…Skeletal muscular tissue is particularly resistant to lesions, being able to bear long periods of ischaemia (Miller & Welch 1949; Hughes 1957; Thompsom et al. 1970; Blaisdell et al.…”

mentioning

confidence: 99%

Ischaemia and reperfusion effects on skeletal muscle tissue: morphological and histochemical studies

Carmo-Araujo

Dal-Pai-Silva

Dal-Pai

et al. 2007

Int J Experimental Path

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show abstract

“…The temporal relationship between ischaemic time and amputation rate is supported by clinical and experimental studies 6,22,23 and generally accepted as one of the most important factors in determining the ultimate fate of a limb with vascular injury; 4,6,8,15 hence, early intervention is associated with improved prognosis. 3,8,15 However, the definition of 'early' differs among authors, some of whom have challenged the traditionally recommended goal of injury to OR time of less than 6 hours and have even demonstrated the benefit of vascular reconstruction in patients with a delay of more than 12 hours.…”

Section: Delayed Amputation 10 33%mentioning

confidence: 98%

“…This approach is regarded as safe and is common practice. 6,8,9,23 We further recommend that the surgical team prioritises revascularisation prior to external fixation if external fixation is likely to proceed beyond the target of 6 hours post injury or 2 hours post presentation to the trauma unit. Owing to the difficulty in accurate post-operative clinical assessment of compartment pressures and the high incidence of compartment syndrome following revascularisation, we strongly recommend that prophylactic fasciotomy is performed following revascularisation in all of these patients, which is supported by previous studies.…”

Section: Delayed Amputation 10 33%mentioning

confidence: 99%

Amputation rate following tibia fractures with associated popliteal artery injuries

et al. 2016

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“…13,66,70 It is vitally important to recognize and treat popliteal artery injury acutely. 67,74 The orthopedic literature has traditionally recommended that arteriography be performed to access vascular injury in all cases of MLKI. 67,73,74 Green and Allen 67 found that when popliteal artery repair was completed within 8 hours of injury, the amputation rate was 11%, but increased dramatically if delayed beyond that time.…”

Section: Associated Injuries (Vascular and Neurologic)mentioning

confidence: 99%