Commentary on 'The ischemic threshold of the extremity'.

摘要

In this issue of Perspectives in Vascular Surgery and Endovascular Therapy, Gifford, Propper, and Eliason present a cogent review of the complexities involved in understanding the pathobiology of skeletal muscle ischemia from the perspective of the battlefield trauma surgeon. In contrast to the vascular injuries encountered by civilian trauma surgeons, the young age and the severity of associated injuries of the patients being treated by battlefield trauma surgeons defines this unique and important clinical scenario. The young age of these patients would theoretically give them the greatest chance to recover and paradoxically a long period of suffering and disability should limb loss occur despite aggressive treatment. The authors acknowledge the strengths and weaknesses of prior work in small- and medium-sized animal models of hind limb ischemia reperfusion injury. In this review, the authors provide a detailed analysis of what may be the most relevant postischemic sequelae, that is, neuromuscular function at 14 days as assessed by electromyographic analysis. This specific quantitative analysis of neuromuscular function was performed in a large animal model that allows concomitant assessment of the role of shock, resuscitation, systemic, and local inflammation to postischemic hind limb recovery. The use of the porcine model is quite appropriate, since it has been used to provide rationale for a successful and rapid implantation of Quik-Clot in first the battlefield and now civilian populations at risk for hemorrhage. The model has provided clinically important information which indicates that the current concept of a 6-hour window of ischemic hind limb tolerance is inaccurate by a substantial margin.