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Functional limb salvage following muscle rigor in a pediatric patient
Brian P Dickinson1, Juan Carlos Jimenez, Peter F Lawrence
1Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Insights
Pediatric acute limb ischemia, even with rigor, may achieve limb salvage. A 10-year-old girl with a 14-hour ischemic event regained function after reperfusion, challenging traditional timelines.
Area of Science:
- Vascular Surgery
- Pediatric Critical Care
- Limb Salvage Surgery
Background:
- Acute limb-threatening ischemia is a critical vascular emergency with a narrow window for intervention.
- Traditionally, irreversible muscle damage and amputation are expected if revascularization exceeds 4-6 hours.
- Ischemic rigor in adults typically signifies irreparable damage and necessitates amputation.
Observation:
- A 10-year-old girl presented with acute left lower extremity ischemia and rigor, 14 hours post-symptom onset.
- The limb was insensate and paralyzed, indicating severe arterial compromise.
- Surgical reperfusion was performed despite the prolonged ischemic time.
Findings:
- Restoration of pulsatile blood flow to the affected lower extremity was achieved.
- The patient regained protective sensation in the limb.
- No significant systemic reperfusion syndrome complications were observed.
Implications:
- This case suggests that pediatric limb salvage may be possible even after extended ischemia with rigor.
- It challenges the traditional understanding of irreversible damage timelines in pediatric acute limb ischemia.
- Further research into pediatric-specific factors influencing limb salvage outcomes is warranted.
Abstract:
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.
