Temporary External Shunt Bypass in the Traumatically Amputated Upper Extremity

Weinstein, Mark H.; Golding, Arthur

doi:10.1097/00005373-197510000-00011

Cited by 19 publications

(4 citation statements)

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“…In case of long ischemia time or crush amputation injury it is helpful to re-vascularize by preliminary arterial shunting [11]. Our guidelines meet those of Sabapathy et al [12,13] in which the sequence of artery and vein repairs is directly influenced by the amount of involved muscle mass in the injured zone and by the ischemia time ( Table 2).…”

Section: Vessel Repairmentioning

confidence: 73%

Macroreplantations of the upper extremity: a series of 11 patients

Leclère

Mathys

Juon

et al. 2012

Arch Orthop Trauma Surg

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Introduction Micro-or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Materials and methods Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). Results All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Conclusion Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. Level of evidence: Level IV

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Section: Vessel Repairmentioning

confidence: 73%

Macroreplantations of the upper extremity: a series of 11 patients

Leclère

Mathys

Juon

et al. 2012

Arch Orthop Trauma Surg

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“…Important anatomic structures (e.g. 27,29 This was used (Fig. 10 In contrast to other algorithms, 16 we prioritize the initial reestablishment of bony integrity (either by plating or external fixation) to ensure an optimal environment for vessel reconstruction 16,19,26 and to protect the anastomoses against shear and traction forces during further management.…”

Section: Discussionmentioning

confidence: 99%

“…We recommend to perform an internal osteosynthesis whenever feasible because no further procedures are required, thus decreasing the risk for secondary complications to reconstructed vessels (obliteration), tendons, or muscles (rerupture). 26,27,29,30 While some authors recommend to prioritize the revascularization (direct repair, venous graft, temporary shunting), 26,27 others recommend to reestablish blood flow to decrease total ischemia time 29 before bony stabilization. 10,20 Thus, the need for grafts for vessel and nerve reconstruction can potentially be avoided, and compartment pressure can significantly be relieved.…”

Section: Discussionmentioning

confidence: 99%

Complete major amputation of the upper extremity

Märdian

Krapohl

Roffeis

et al. 2015

Journal of Trauma and Acute Care Surgery

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“…Temporary arterial shunting has been suggested to expedite revascularization in patients with traumatic arterial injuries, and was first reported in 1971 by Eger et al 16 Since then, the use of shunting has been repeatedly reported, and several authors have supported the utility of this rational approach in selected patients with civilian complex upper and lower limb vascular injuries. 15,[17][18][19][20][21] Others have used shunts during extremity reimplantation, 22 and more recently as a component of damage control management in patients with severe, multisystem trauma. 23,24…”

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confidence: 99%