This paper presents a non-contact and cost-effective method to assess venous hemodynamics along the lower limbs using photoplethysmography imaging (PPGI). Seventeen healthy volunteers performed the venous muscle pump test, inducing venous blood volume changes in their lower legs, which were recorded using a webcam. PPGI signals were extracted from three regions along the lower leg. Key parameters derived from a physiological model were evaluated and analyzed statistically: perfusion amplitude, ejection time constant, and peripheral venous flow index. The method demonstrated robust estimation of physiologically explainable parameters, and the potential to improve venous function diagnostics with high spatial resolution.

• Publikační typ
• časopisecké články MeSH

Úvod: Arteria profunda femoris (APF) je důležitou tepnou, která v případě postižení arteria femoralis superficialis (AFS) zabezpečuje perfuzi tkání dolní končetiny přes tzv. kolaterální řečiště. Izolovaná angiochirurgická rekonstrukce, plastika APF (profundoplastika), je ve vědecké literatuře diskutovaným tématem, co se týče významu kolaterálního řečiště a jeho přínosu ke zlepšení klinického stavu pacienta. Cílem projektu je zhodnotit dopad izolované profundoplastiky na zlepšení prokrvení dolní končetiny, a tím přispět v rozhodovacím procesu indikace tohoto typu výkonu. Metodika: Do této prospektivní monocentrické studie byli zahrnuti pacienti se symptomatickou ischemickou chorobou dolních končetin (ICHDK) ve stadiu klaudikačních potíží, klidových bolestí nebo s tkáňovým defektem hodnoceným dle Rutherfordovy klasifikace stupněm 1 až 5. Kritériem pro zařazení byla významná stenóza APF s konkomitantním uzávěrem AFS a insuficientním výtokem pro bypass. S odstupem jednoho a šesti měsíců od výkonu byly hodnoceny změny klaudikačního intervalu, Rutherfordova klasifikace a přítomnost chronické končetinu ohrožující ischemie (CLTI). Měření transkutánní tenze kyslíku (TcpO 2 ) bylo využito k objektivizaci úrovně perfuze a oxygenace tkání. Výsledky: V průběhu dvou let byla profundoplastika provedena u 45 pacientů – u 23 pacientů klaudikantů a 22 pacientů s CLTI (9 s klidovou bolestí, 13 s ischemickým defektem). Ve skupině klaudikantů došlo k prodloužení klaudikačního intervalu ze 128 m před operací na 505 m po šesti měsících od revaskularizace. Ve skupině CLTI došlo k signifikantnímu zlepšení a vymizení klidových bolestí u všech pacientů, což bylo objektivizováno zlepšením TcpO 2 na bérci o 52 % na hodnotu 52 mm Hg a na dorzu chodidla o 143 % na hodnotu 35,8 mm Hg. Ovlivnění osudu těžších forem CLTI jenom izolovanou profundoplastikou je již obtížnější úkol a i tak došlo ke zhojení akrálního ischemického defektu u 61,5 % pacientů s přežitím bez potřeby amputace (amputation free survival) po šesti měsících 76 %, kdy tři pacienti v průběhu sledování podstoupili vysokou amputaci ve stehně. U pacientů s defektem byl pooperačně také pozorován nárůst hodnot TcpO 2 , kdy na bérci a nártu došlo k 1,3- a 1,6násobnému zvýšení hodnot (na 43 mm Hg, resp. 27 mm Hg). Závěr: Profundoplastika jako izolovaná procedura revaskularizace pacientů s ICHDK je nadále metodou volby u selektivní skupiny pacientů. Dle naší studie je nejefektivnější k léčbě klidových bolestí nebo k prodloužení klaudikačního intervalu, ale může přispět i k hojení menších akrálních defektů. V literatuře absentující konsenzus na tzv. TcpO 2 threshold pro hojení defektů byl naší studií pozorován při hodnotě 27 mm Hg, resp. 35,8 mm Hg pro vymizení klidových bolestí.

Introduction: Profunda femoris artery (PFA) is an important artery that provides perfusion of the lower limb tissues via collateral circulation in case of superficial femoral artery (SFA) occlusion. Isolated angiovascular reconstruction, APF reconstruction (profundoplasty), is a debated topic in the scientific literature regard- ing the importance of collateral circulation and its contribution to improving the patient's clinical condi- tion. This project aims to evaluate the impact of isolated profundoplasty on the improvement of lower limb perfusion and thus to contribute to the decision-making process for the indication of this type of procedure. Methods: This prospective single-center study enrolled patients with peripheral artery disease (PAD) in the stage of claudication, rest pain or presence of tissue foot ulcer assessed according to Rutherford classification grade 1 to 5. Inclusion criteria were significant AFP stenosis with concomitant AFS closure and no distal runoff to the feet. Changes in claudication interval, Rutherford classification, and presence of chronic limb-threatening ischemia (CLTI) were assessed at one and six months after surgery. Transcutaneous oxygen tension (TcpO2 ) was measured to objectify the tissue perfusion and oxygenation level. Results: During two years, profundoplasty was performed in 45 patients, 23 claudicants, and 22 CLTI patients (9 with rest pain, 13 with foot ulcer). The claudicant group’s intermittent claudication interval was prolonged from average 128 metres (m) preoperatively to 505 m six months after revascularization. In the CLTI group, there was a significant improvement and disappearance of rest pain in all patients, which was objectified by an improvement in TcpO2 on the calf by 52% to 52 mmHg and on the dorsum of the foot by 143% to 35.8 mmHg. Controlling the fate of more severe forms of CLTI by isolated profundoplasty alone is already a more difficult task, and even so, healing of the acral ischemic defect occurred in 61.5% of patients with amputation free survival at six months of 76%, with three patients undergoing high amputation in the thigh during follow-up. Postoperatively, an increase in TcpO 2 values was also observed in patients with the foot ulcer, with 1.3 and 1.6 times increases in the tibia and calcaneus (to 43 mmHg and 27 mmHg, respectively). Conclusion: Profundoplasty as an isolated procedure for revascularization of patients with PAD remains the method of choice in a selective group of patients. Our study shows it is the most effective for treating rest pain. However, it may contribute to healing of smaller acral ulcers or prolong the claudication interval. The lack of consensus in the literature on the so-called TcpO2 threshold for defect healing was observed by our study at 27 mmHg and 35.8 mmHg for resolution of rest pain, respectively.

• Klíčová slova
• profundoplastika,
• MeSH
• chronická kritická ischemie končetin * chirurgie   patologie   MeSH
• dolní končetina chirurgie   krevní zásobení   patologie   MeSH
• intermitentní klaudikace chirurgie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• statistika jako téma MeSH
• transkutánní měření krevních plynů metody   přístrojové vybavení   statistika a číselné údaje   MeSH
• výkony cévní chirurgie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

OBJECTIVES: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN: A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry. PATIENTS: All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020. INTERVENTIONS: Unilateral or bilateral femoral cannulation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching. CONCLUSIONS: This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.

• MeSH
• arteria femoralis MeSH
• dospělí MeSH
• ischemie etiologie   MeSH
• kompartment syndrom * MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• mortalita v nemocnicích MeSH
• periferní katetrizace * metody   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications. Multiple alternative cannulation techniques to the distal perfusion cannula have been developed to maintain distal limb perfusion, including end-to-side grafting, external or endovascular femoro-femoral bypass, retrograde limb perfusion (e.g., via the posterior tibial, dorsalis pedis or anterior tibial artery), and, more recently, use of a bidirectional cannula. Venous congestion has also been recognized as a potential contributing factor to limb ischaemia development and specific techniques have been described with facilitated venous drainage or bilateral cannulation being the most recent, to reduce or avoid venous stasis as a contributor to impaired limb perfusion. Advances in monitoring techniques, such as near-infrared spectroscopy and duplex ultrasound analysis, have been applied to improve decision-making regarding both the monitoring and management of limb ischaemia. This narrative review describes the evolution of techniques used for distal limb perfusion during peripheral VA ECMO.

• MeSH
• arteria femoralis * MeSH
• dospělí MeSH
• ischemie prevence a kontrola   etiologie   MeSH
• katetrizace metody   MeSH
• končetiny krevní zásobení   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• perfuze metody   MeSH
• periferní katetrizace metody   škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. METHODS: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. RESULTS: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training. CONCLUSION: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP.

• MeSH
• chemoterapie nádorů pomocí regionální perfúze * metody   MeSH
• delfská metoda MeSH
• končetiny * krevní zásobení   MeSH
• konsensus MeSH
• lidé MeSH
• nádory MeSH
• TNF-alfa MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: Normothermic ex situ perfusion of vascularized composite allografts (VCAs) necessitates high oxygen demand and, thus, increased metabolic activity, which, in turn, requires the use of blood-based perfusion solutions. However, blood-derived perfusates, in turn, constitute an antigenic load. To circumvent this immunogenic problem, we used a perfusate enriched with acellular dextrane oxygen microcarriers to perfuse rat hindlimbs. METHODS: Rat hindlimbs (n = 11) were perfused with either (non-), oxygenated dextrane-enriched Phoxilium, or Phoxilium enriched with dextrane oxygen microcarriers (MO2) for 12 h at 37 °C or stored on ice. Oxygenation of the skeletal muscle was assessed with Raman spectroscopy, tissue pO2-probes, and analysis of the perfusate. Transmission electronic microscopy was utilized to assess the ultrastructure of mitochondria of the skeletal muscle. RESULTS: For all evaluated conditions, ischemia time until perfusion was comparable (22.91 ± 1.64 min; p = 0.1559). After 12 h, limb weight increased significantly by at least 81%, up to 124% in the perfusion groups, and by 27% in the static cold storage (SCS) group. Raman spectroscopy signals of skeletal muscle did not differ substantially among the groups during either perfusion or static cold storage across the duration of the experiment. While the total number of skeletal muscle mitochondria decreased significantly compared to baseline, mitochondrial diameter increased in the perfusion groups and the static cold storage group. CONCLUSION: The use of oxygen microcarriers in ex situ perfusion of VCA with acellular perfusates under normothermic conditions for 12 h facilitates the maintenance of mitochondrial structure, as well as a subsequent recovery of mitochondrial redox status over time, while markers of muscle injury were lower compared to conventional oxygenated acellular perfusates.

• Publikační typ
• časopisecké články MeSH

Remote ischemic preconditioning (RIPC) represents one of the forms of innate cardioprotection. While being effective in animal models, its application in humans has not been always beneficial, which might be attributed to the presence of various comorbidities, such as hypertension, or being related to the confounding factors, such as patients' sex and age. RIPC has been shown to mediate its cardioprotective effects through the activation of Reperfusion Injury Salvage Kinase (RISK) pathway in healthy animals, however, scarce evidence supports this effect of RIPC in the hearts of spontaneously hypertensive (SHR) rats, in particular, in relationship with aging. The study aimed to investigate the effectiveness of RIPC in male SHR rats of different age and to evaluate the role of RISK pathway in the effect of RIPC on cardiac ischemic tolerance. RIPC was performed using three cycles of inflation/deflation of the pressure cuff placed on the hind limb of anesthetized rats aged three, five and eight months. Subsequently, hearts were excised, Langendorff-perfused and exposed to 30-min global ischemia and 2-h reperfusion. Infarct-sparing and antiarrhythmic effects of RIPC were observed only in three and five months-old animals but not in eight months-old rats. Beneficial effects of RIPC were associated with increased activity of RISK and decreased apoptotic signaling only in three and five months-old animals. In conclusion, RIPC showed cardioprotective effects in SHR rats that were partially age-dependent and might be attributed to the differences in the activation of RISK pathway and various aspects of ischemia/reperfusion injury in aging animals.

• MeSH
• hypertenze * prevence a kontrola   MeSH
• infarkt myokardu * metabolismus   MeSH
• ischemie MeSH
• kojenec MeSH
• krysa rodu rattus MeSH
• lidé MeSH
• potkani inbrední SHR MeSH
• reperfuzní poškození myokardu * metabolismus   MeSH
• zvířata MeSH
• Check Tag
• kojenec MeSH
• krysa rodu rattus MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Ageing skeletal muscles become both insulin resistant and atrophic. The hormone glucagon-like peptide 1 (GLP-1) facilitates postprandial glucose uptake as well as augmenting muscle perfusion, independent of insulin action. We thus hypothesized exogenous GLP-1 infusions would enhance muscle perfusion and positively affect glucose metabolism during fed-state clamps in older people. METHODS: Eight men (71 ± 1 years) were studied in a randomized crossover trial. Basal blood samples were taken before postprandial (fed-state) insulin and glucose clamps, accompanied by amino acid infusions, for 3 hours. Reflecting this, following insertions of peripheral and femoral vessels cannulae and baseline measurements, peripheral IV infusions of octreotide, insulin (Actrapid), 20% glucose, and mixed amino acids; Vamin 14-EF with or without a femoral arterial GLP-1 infusion were started. GLP-1, insulin, and C-peptide were measured by ELISA. Muscle microvascular blood flow was assessed via contrast enhanced ultrasound. Whole-body glucose handling was assayed by assessing glucose infusion rate parameters. RESULTS: Skeletal muscle microvascular blood flow significantly increased in response to GLP-1 vs feeding alone (5.0 ± 2.1 vs 1.9 ± 0.7 fold-change from basal, respectively; P = 0.008), while also increasing whole-body glucose uptake (area under the curve 16.9 ± 1.7 vs 11.4 ± 1.8 mg/kg-1/180 minutes-1, P = 0.02 ± GLP, respectively). CONCLUSIONS: The beneficial effects of GLP-1 on whole-body glycemic control are evident with insulin clamped at fed-state levels. GLP-1 further enhances the effects of insulin on whole-body glucose uptake in older men, underlining its role as a therapeutic target. The effects of GLP-1 in enhancing microvascular flow likely also affects other glucose-regulatory organs, reflected by greater whole-body glucose uptake.

• MeSH
• glukagonu podobný peptid 1 * metabolismus   MeSH
• glukosa metabolismus   MeSH
• inzulin * metabolismus   MeSH
• kosterní svaly metabolismus   MeSH
• krevní glukóza metabolismus   MeSH
• lidé MeSH
• oktreotid farmakologie   MeSH
• perfuze MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

Úvod: Umělé kožní náhrady se postupně vyvinuly pro řešení popálenin a defektů v obecné chirurgii. V onkologické chirurgii se používají zejména u kožních nádorů, kde je hlavní indikací dokončení resekce okrajů po neúplné excizi (R1,2). Toto není indikací u sarkomů, kde je vždy primární snahou široké odstranění nádoru (R0). Smyslem práce je ukázat možné vzácné indikace pro umělé dočasné kožní krytí (UDKK). S rozvojem nových možností rekonstrukční chirurgie se snižují zejména zánětlivé komplikace, ale současně se prodlužuje i operační čas a krevní ztráty. Materiál a metody: Ze souboru 594 pacientů se sarkomy měkkých tkání končetin operovaných od 1. 1. 2014 na ortopedické klinice FN Bulovka v Praze bylo vybráno 97 pacientů s lalokovými plastikami či UDKK a z těch byl zhodnocen soubor pacientů, kde bylo použito UDKK. Výsledky: UDKK bylo použito u 11 pacientů. Ve dvou případech byl použit Aquagel, ve čtyřech Parasorb a v pěti COM 30. Nejčastějšími lokalitami byla noha (6×), femur (3×) a bérec (2×). V sedmi případech se jednalo o nediferencované sarkomy, ve dvou o synoviální sarkomy a v jednom případě myxofibrosarkom a MPNST. V pěti případech bylo indikováno překrytí šlach, ve čtyřech kosti a v jednom případě cévy. Deset z 11 indikací byly recidivující sarkomy, kde byl plánovaný rozsáhlejší rekonstrukční výkon, hrozilo riziko zánětu nebo nebyla jasná histologie. Další vhodná indikace UDKK je možnost dvoudobé operace u sarkomů měkkých tkání končetin k zamezení nežádoucích účinků protrahovaného operačního výkonu na perfuzi laloků i pacienta. Diskuze: Je diskutován nejen anesteziologický, ale i onkologický vliv protrahované anestezie na pacienta jakož i vliv možných komplikací takové anestezie na vitalitu laloků. Dále jsou rozebrány jednotlivé indikace a jejich alternativní řešení, výhody a nevýhody. Závěr: UDKK je dobré řešení umožňující následnou bezpečnou rekonstrukci na erudovaném pracovišti plastické chirurgie v plném komfortu. I když jsou tyto indikace vzácné, mělo by být toto řešení v repertoáru pracovišť zabývajících se onkologickou problematikou. Dvoudobé řešení může být bezpečnější z hlediska peroperační perfuze zejména volných laloků a může příznivě ovlivnit i celkový stav onkologického pacienta.

Introduction: Artificial skin replacements were developed to cover defects in general surgery or after burns. Their main indication in oncologic surgery is secondary resection of appropriate margins in skin tumors after incomplete primary excision. This is contraindicated in sarcomas where only wide excision is indicated. The aim of the study is to show rare possible indications for temporary skin closure (TSC) in extremity soft tissue sarcomas (STS). Materials and methods: Out of 594 patients with extremity STS treated surgically at the Department of Orthopedics, University Hospital Bulovka, Prague, since 2014, we evaluated those with TSC concerning their indications. Results: TSC (Aquagel twice, Parasorb four times, and COM 30 five times) was used in 11 patients. Six cases were on the foot, three on the femur and two on the lower legs. Seven cases were high-grade sarcomas, two cases were synovial sarcomas, one case was low-grade myxofibrosarcoma and one case was low-grade malignant peripheral nerve sheath tumor. We covered tendons five times, bones four times and vessels once. Ten of the 11 cases were recurrent tumors with extensive reconstructions, an increased risk of infection or unclear final histology. Two-stage surgeries seem good indications to decrease the adverse effects of prolonged surgery on flap perfusion or patient’s status. Discussion: Not only the anesthesiologic, but also oncologic factors, potentiating the adverse effects of prolonged surgery on the patient and flaps, are discussed. The pros and cons of individual indications and their alternatives are compared. Conclusion: The indications for TSC in extremity STS are rare, but exist. TSC can be a good solution, enabling a safe two-stage reconstruction at a specialized plastic surgery unit, after an initial wide excision at a department of oncologic surgery. This can be a safer method concerning the perfusion of flaps and general status of an oncologic patient.

• MeSH
• chirurgické laloky MeSH
• dolní končetina chirurgie   patologie   MeSH
• lidé MeSH
• nádory měkkých tkání * chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• sarkom chirurgie   diagnóza   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• lidé MeSH

Úvod: Článek o akutním spontánním kompartment syndromu horní končetiny vydaný v časopisu Rozhledy v chirurgii 8/2021 byl podnětem k uveřejnění naší kazuistiky týkající se spontánního kompartment syndromu na obou horních končetinách rozvinutého po zaledování pohmožděnin. Kazuistika: Muž, 43 let, byl přijat na oddělení chirurgie ve večerních hodinách pro masivní bolestivý otok obou horních končetin. Otok vznikl bezprostředně po zaledování pohmožděnin po pravděpodobném pádu předchozí den v ebrietě. Byla provedena diagnostika kompartment syndromu levé ruky a pravého předloktí, následně adekvátní dermatofasciotomie s reverzí stavu k normě na obou horních končetinách. Došlo ke zhojení ad integrum bez poruch prokrvení, hybnosti či čití na obou horních končetinách. Závěr: Netraumatický kompartment syndrom horní končetiny je v literatuře popsán jen málo a na běžných chirurgických ambulancích je poměrně vzácným akutním stavem. Přesto je třeba tuto nosologickou jednotku znát, rozpoznat a včas se rozhodnout pro správné ošetření, neboť v opačném případě může dojít k trvalému vážnému poškození pacienta.

Introduction: The publishing of our case report on an idiopathic compartment syndrome of both upper limbs after icing a contusion trauma was motivated by another article on the acute spontaneous compartment syndrome of upper limb published in Rozhledy v chirurgii 8/2021. Case report: We present the case of a 43-year-old man admitted in the evening for painful massive swelling of both upper extremities. The swelling developed immediately after icing his bruises suffered due to a probable fall on the previous day in a state of inebriety. Compartment syndrome of the left hand and right forearm was diagnosed; subsequently, adequate dermatofasciectomy resulted in normalization of the condition in both upper limbs. The patient’s condition was cured to a full extent without any disorders of perfusion, mobility or sensation in both upper extremities. Conclusion: Only few reports on the atraumatic compartment syndrome of upper extremity can be found in the literature and it is an acute condition encountered quite rarely at outpatient offices of surgery. Nevertheless, we need to be able to recognize this nosological unit and provide proper treatment in time, otherwise the patient may suffer serious permanent damage.

• MeSH
• dospělí MeSH
• kompartment syndrom * chirurgie   diagnóza   MeSH
• lidé MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH