Functional limb salvage following muscle rigor in a pediatric patient.
Acute limb-threatening ischemia is a vascular surgical emergency. Traditionally, 4 to 6 hours are usually available from the onset of acute ischemia to successfully revascularize before irreversible damage occurs. The presence of ischemic rigor traditionally represents irreparable local damage to muscle in the adult population and is an indication for limb amputation. Although the literature is scarce on this topic, few authors have reported superior limb salvage rates in pediatric patients despite the presence of severely impaired arterial perfusion. We present a case of a 10-year-old girl with rigor of the left lower extremity, who underwent surgical reperfusion for acute ischemia approximately 14 hours after the initiation of symptoms. The patient presented with an insensate and paralyzed limb. Pulsatile flow was restored to her lower extremity. She regained protective sensation and suffered no significant sequelae of systemic reperfusion syndrome.
Dickinson
Brian P
BP
Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Jimenez
Juan Carlos
JC
Lawrence
Peter F
PF
Derubertis
Brian G
BG
D000208:Acute Disease; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D009135:Muscular Diseases / Q000209:etiology* / Q000503:physiopathology; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D016038:Skin Transplantation; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler