Permissible ischemia time for a proximal limb amputations:
Irreversible necrotic changes begin in muscles after 6 hours of ischemia (warm ischemia time), it is preferable to begin the replantation of pas with good muscular bulk (viz. pas proximal to palms and foot) within this time. With cooling (to 4degC), this time may be extended to 12 hours (cold ischemia time). Sequence of reimplantation (Mnemonic: BE FAN VS ) B- Bone (first to be implanted) E- Extensor tendon F- Flexor tendon A- Aeries N- Nerves V- Veins S- Skin (preserved first implanted last)
4 hours
6 hours
8 hours
12 hours
Amputations and Spos Injury