Fasciotomy Before Reperfusion In Upper Extremity Replantation:Experimental Study And Clinical Application

Objective:To investigate the preventive and protective effects of fasciotomy against ischemia reperfusion injury of skeletal muscle in upper extremity replantations, and to compare the effects of the treatment between pre-reperfusion fasciotomy and post-reperfusion fasciotomy against ischemia reperfusion injury of skeletal muscle.Methods:1.24healthy male Japanese white rabbits were used in the experiment. The animals were divided randomly into3groups with eight rabbits in each. Reperfusion was performed after4hours ischemia in group A, post-reperfusion fasciotomy was performed after4hours ischemia in group B, and pre-reperfusion fasciotomy was performed after4hours ischemia in group C.2. Using a rabbit amputation-like model, Japanese white rabbits underwent temporary amputation at the level of left femur excluding the femoral vessels.3. By measuring MDA, MPO, the extent of skeletal muscle death and apoptosis, Bax and Bcl-2, the preventive and protective effects of fasciotomy were observed, and the effects of the treatment between pre-reperfusion fasciotomy and post-reperfusion fasciotomy against ischemia reperfusion injury of skeletal muscle were compared.4. Pre-reperfusion fasciotomy were performed in11cases of upper extremity replantations clinically.Result:1. When skeletal muscle was reperfused for1hour after4hours ischemia, post-reperfusion fasciotomy could protect skeletal muscle against ischemia reperfusion injury, it could not only reduce MDA and MPO in the reperfused areas, but also could reduce the extent of muscle death and apoptosis, in the reperfused areas anti-apoptosis factor Bcl-2increased and Bax decreased.2. When skeletal muscle was reperfused for1hour after4hours ischemia, pre-reperfusion fasciotomy could protect skeletal muscle against ischemia reperfusion injury, it could not only reduce MDA and MPO in the reperfused areas, but also could reduce the extent of muscle death and apoptosis, in the reperfused areas anti-apoptosis factor Bcl-2increased and Bax decreased.3. When skeletal muscle was reperfused for1hour after4hours ischemia, the MDA level of blood and skeletal muscle in group B was higher than group C, there were significant different between the two groups. When skeletal muscle was reperfused for1hour after4hours ischemia, the MPO level of blood and skeletal muscle in group B was higher than group C, there were significant different between the two groups. When skeletal muscle was reperfused for6hours after4hours ischemia, the apoptosis factor Bax level of skeletal muscle in group B was higher than group C, but no significant different was found between the two groups. When skeletal muscle was reperfused for6hours after4hours ischemia, the anti-apoptosis factor Bcl-2level of skeletal muscle in group B was lower than group C, but no significant different was found between the two groups.4. All11replanted upper extremities survived completely without postoperative vascular crisis.Conclusion:1. When skeletal muscle was reperfused after ischemia, pre-reperfusion fasciotomy or pre-reperfusion fasciotomy could protect skeletal muscle of Japanese white rabbits against ischemia reperfusion injury, it could not only reduce the extent of muscle death, but also could reduced the level of apoptosis in the reperfused areas.2. The preventive and protective effects of pre-reperfusion fasciotomy against ischemia reperfusion injury of skeletal muscle are better than of post-reperfusion fasciotomy in Japanese white rabbits.3. The mechanism of preventive and protective effects of pre-reperfusion fasciotomy against ischemia reperfusion injury of skeletal muscle is still in research.