<- Home <- Arhive <- Vol. 16, Issue 2, June 2008

Rom J Leg Med16(2)134-140(2008)
© Romanian Society of Legal Medicine

Lethal potential of reperfusion syndrome – forensic signification

O. Lupescu, A. Sirbu, M. Nagea, D. Sirbu

Abstract: Lethal potential of reperfusion syndrome – forensic signification. The reperfusion syndrome (SRT) is the consequence of cellular lesions which occurs in an ischemic area after the blood stream and oxygen supply are reestablished, usually, by surgical procedure. We report the case of a blast victim (a 20 year old male working as a fireman), presented in emergency ward with diagnosis of “Work accident (explosion). Multiple traumas. Minor craniocerebral trauma level 1. Chest and abdominal contusion. Right femoral opened fracture III C type with angular displacement. Femoral artery injury. Avulsion of the skin from lateral side of right thigh. Contusion wounds on the anterior side of both thigh. Traumatic and hemorrhagic shock” An emergency surgical intervention was performed consisting in femoral ostheosynthesis, suture of the femoral artery, internal and external decompressive fasciotomy of right calf. Unexpectedly after surgery, the condition of the patient grew rapidly worse. The evolution of biological parameters and clinical status showed the beginning of metabolic alterations that characterized SRT (creatinkynase: at admission = 892 UI/L, 3 hours after revascularization = 2428 UI/L, 24 hours after revascularization = 20000 UI/L; Hemoglobin: 4 hours after surgery = 6,2 mg/dL, 24 hours after surgery = 5, 8 mg/dL; platelets 4 hours after surgery = 46.000/mmł, 24 hours after surgery =51.000/ mmł), which rapidly evolved towards a with MSOF. A right thigh amputation was decided as a life saving procedure. This case support the conclusion that the blood level of CK represents a useful marker (sometimes better than any other) of the amplitude of irreversible muscular tissue damages determined by prolonged ischemia or contusive trauma. It might also represent a useful criterion in forensic cases when evaluating the life endangering potential of trauma or when assessing if the decision to amputate a limb was inappropriate.
Keywords: ischemia, reperfusion syndrome, cretinkynase, amputation

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