Risk of Reperfusion Injury in Isolated Hyperthermic Limb Perfusion

Mitáš Petr, Hodková Gabriela, Pecha Ondřej, Vejražka Martin, Novotný Robert, lubocký Jaroslav, Špunda Rudolf, Lindner Jaroslav and Špaček Miroslav

Department of Cardiovascular Surgery, General University Hospital, Charles University in Prague, Czech Republic
Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
The Institute of Medical Chemistry and Biochemistry, Charles University in Prague, Czech Republic
Department of Strategic Studies, Technology Centre, Czech Academy of Science, Prague, Czech Republic

^*Correspondance to: �pa?ek Miroslav 

 PDF  Full Text DOI: 10.25107/2474-1647.2138

Abstract

Aim: Isolated hyperthermic limb perfusion (IHLP) is a standard treatment method for selected patients with local recurrence of melanoma with frequent in-transient metastases in the lower or upper limb, and for selected patients with advanced soft tissue sarcomas of the extremity. Extremely high concentrations of cytotoxic drugs administered during perfusion, hyperthermia and hypoxia followed by reoxygenation during the procedure are potential risk factors for development of compartment syndrome. The presented study addresses safety of the procedure with respect to compartment syndrome, assessing several biochemical parameters in blood sampled from the perfused limb.Methods: In the time period from September 2009 till December 2010 we performed a total of 20 cytostatic IHLP in 17 patients. Metabolic (lactate, base excess, pH) and haematological parameters (haemoglobin, hematocrit) were measured in the blood of perfused extremity. Risk of compartment syndrome was estimated according to our previous study on acute limb ischemia.
Results: In the short term, no serious complications were associated with the procedure. Postoperative swelling and erythema of grade 2 to 3 according to Wieberdin's classification were present in most of the patients. However, markers of tissue damage and reperfusion injury did not exceed limits indicating risk of compartment syndrome or severe systemic complications.Conclusion: The affected limb is exposed to extreme conditions that lead to significant changes of local metabolism. However, despite the hypoxia during the procedure, these transient alterations do not lead to a clinically significant compartment syndrome or to severe systemic complications. Thus, IHLP can be considered a safe treatment modality in selected patients.

Keywords

Isolated hyperthermic perfusion; Melanoma; Compartment syndrome; Melphalan; Reperfusion injury

Cite the article

Petr M, Gabriela H, Ond?ej P, Martin V, Robert N, Jaroslav l. Risk of Reperfusion Injury in Isolated Hyperthermic Limb Perfusion. Clin Surg. 2018; 3: 2138.