Systemic reperfusion injury during arm replantation requiring intraoperative amputation

This case describes the attempted replantation of an arm following its traumatic amputation. After a five-and-a-half hour ischaemic time, perfusion of the arm was re-established. However over the ensuing hours, the patient developed hyperkalaemia, acidaemia and severe hypotension requiting high dose inotropic support. Ultimately re-amputation was necessary to treat the systemic effects of the ischaemia reperfusion syndrome.