Acta Chir Belg
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Revascularization of a limb after a severe and prolonged period of ischemia may be associated with high rates of mortality and amputation, because of the development of a postrevascularization syndrome, regardless the cause of occlusion (ischemia, trauma, iatrogenic) or the methods used to achieve reperfusion (fibrinolysis, surgery, resuscitative therapy). This "revascularization" syndrome includes several complications, both local (explosive swelling of the limb, compartment syndrome and skeletal muscle infarction (rhabdomyolysis) and general (acidosis, hypercalcemia, hypovolaemic shock, renal, hepatointestinal and pulmonary failures, arrhythmias and cardiac arrest (multiple organ dysfunction). ⋯ Intra and extraacellular swelling, tissue acidosis, free radical mediated damage, loss of adenine nucleotide precursors, and intracellular calcium overload have been suggested to be the mechanisms responsible for reperfusion injury. Careful control of both the composition and the physical conditions of the initial reperfusion (controlled reperfusion) may result, in selected cases, in improvements in the metabolism, structure and function of the limb after reperfusion.
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Postoperative chylothorax is an infrequent but potential life-threatening complication and has most often been described following oesophageal resection. Its incidence after pulmonary resection is low, but has increased to 0.3-0.5%, probably due to more extensive types of resections and radical lymph node dissections. ⋯ Five additional case reports in English and French literature confirmed chylothorax after bronchoplastic procedures to be extremely rare. More frequent use of bronchial sleeve resection as alternative to pneumonectomy to save functional lung tissue, can increase the incidence of chylothorax after bronchoplastic procedures.
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Acute compartment syndrome is a serious complication of injury. It occurs when raised pressure within a closed osteofascial compartment compromises the circulation and function of tissues within the compartment. Most cases are caused by fracture. ⋯ The recommended tissue pressure threshold for decompression has been variable through the years but should be related to the patient's blood pressure. A difference of less than 30 mmHg between the diastolic and tissue pressures has been validated clinically and it is recommended that at this level serious consideration should be given to decompression of the affected compartments. Use of this pressure threshold with compartment monitoring has been shown to half the delay to fasciotomy and significantly reduces the late complications of acute compartment syndrome.