Upper limb replantation: Surgical strategy and the prophylaxis of acute renal failure in ischemia reperfusion injury: A report of two cases

Abstract

Introduction. The arm replantation is extremely rare and challenging procedure. The recognised risk is myoglobinuria and ischemia reperfusion induced renal failure. Case report. Two patients aged 24 and 46-years were admitted after traumatic arm amputation. Ischemia time was two hours and six hours. Postoperative intensive care treatment with assisted ventilation, sedation and obtaining sufficient urine output prevents myoglobin induced renal injury. In case where ischemia time was shorter, there was only one delayed reconstruction of skin defects after fasciotomy, but in the case where ischemia lasted longer, patient had two secondary look procedures with acceptable definitive results. Conclusion. Arm replantation is safe procedure even in cases with longer ischemia time. Postoperative control of urine output and correction of acidosis, preventing myoglobin induced tubular injury is crucial for stable postoperative recovery.