The Impact of ischaemia on limb replantation

Abstract

Traumatic amputations of the extremity are relatively common catastrophic injuries that adversely affect a patient’s physical function and wellbeing. This article reviews the current management of amputated limbs and discusses the role of ischemia and reperfusion processes in its future management. The decision to replant an extremity depends on numerous factors which include, but are not limited to, the time from injury, mechanism and site of injury, patient factors, and technic Traumatic amputations of the extremity are relatively common catastrophic injuries that adversely affect a patient’s physical function and wellbeing. This article reviews the current management of amputated limbs and discusses the role of ischemia and the reperfusion processes in its future management. The decision to replant an extremity depends on numerous factors which include, but are not limited to, the time from injury, mechanism of injury, site of injury, patient factors and technical know-how of replantation surgery. Despite the significant progress in most of these aspects over the last decades, the management of the amputate has not significantly advanced. The outcomes of replantation are related to the amount of tissue injury incurred by the amputate and the time without blood supply. To further the optimisation of the amputated extremity and improve the success of replantation, the future of this field relies in the research into both pharmacological post-conditioning and ex vivo perfusion to overcome Ischemic Reperfusion Injury, particularly in proximal injuries. al know-how of replantation surgery. Despite the significant progress in most of these aspects over the last decades, the management of the amputate has not significantly advanced. The outcomes of replantation are related to the amount of tissue injury incurred by the amputate and the time without blood supply. To further the optimization of the amputated extremity and improve replantation success, the future of this field relies on the research into both pharmacological post-conditioning and ex vivo perfusion to overcome Ischaemic Reperfusion Injury, particularly in proximal injuries.