Hand Replantation is not Adversely Affected by Prior Ice Immersion: The Physiological Role of Ice in the Transport of Amputated Limbs

  • Harnarayan P
  • Seepaul T
  • Lalla R
  • Islam S.
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Harnarayan P, Seepaul T, Lalla R, and Islam S., “Hand Replantation is not Adversely Affected by Prior Ice Immersion: The Physiological Role of Ice in the Transport of Amputated Limbs ”, ijmhs, vol. 12, no. 05, pp. 1892–1897, May 2022.
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Abstract

Background: One of the most challenging operations in reconstructive surgery is the replanting of an amputated hand. Instituted protocols for the transport of the limb to hospital exist to allow it to remain cooled and therefore salvageable to the surgical team for replantation. This paper looks at limb preservation prior to replantation with the transport medium being analysed to see how it relates to the existing evidence on limb cooling. Methods:Three cases of hand amputation werereferred forreplantation with two cases transported in ice arriving at hospital in a viable state without icicle formation nor maceration of the tissue. One wastransported neither in a plastic container placed in ice nor directly in ice.All three underwent replantation, two being the dominant hands. Results: The outcomes of three cases were matched with the method of transport used for each limb. The two limbs which were transported in ice were replanted with veryfavorable short and long-term outcomes. The other hand initially appeared to be viable but intrinsic hand muscle necrosis lead to a poor outcome. Conclusion The significant change that occurs during cooling has been experimentally shown to be alkalinization of muscle cells which offsets the deadly effects acidosis, produced by muscle ischemia, has on the muscle cells. This and not the drop in metabolic activity due to the temperature drop,causes tissue preservation prior to and during replantation.Direct immersion on ice is therefore not a contraindication to surgical repair.

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