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Original article

The effect of tourniquet reperfusion interval on malondialdehyde (MDA) level and skeletal muscle damage in the treatment of long bone fractures

By
Adhi Satriyo Utomo Orcid logo ,
Adhi Satriyo Utomo
Contact Adhi Satriyo Utomo

Orthopaedic and Traumatology Department, Faculty of Medicine, University of Brawijaya , Malang , Indonesia

Thomas Erwin Christian Junus Huwae Orcid logo
Thomas Erwin Christian Junus Huwae

Orthopaedic and Traumatology Department, Faculty of Medicine, Universitas Brawijaya, RSUD Prof. Dr. Saiful Anwar Malang , Malang , Indonesia

Editor: SELMA UZUNOVIĆ

Abstract

Aim Tourniquets are commonly used during surgery to control bleeding; however, their application can lead to complications, including ischemic reperfusion injury. Post-tourniquet syndromes such as pain, swelling, and muscle weakness may persist for up to six weeks. Aim of this study was to investigate the reperfusion interval duration to prevent muscle tissue damage.

Methods This experimental study involved 48 male white rats (Rattus norvegicus) with induced tibial fracture. The rats were divided into two groups, A and B, with each group receiving four different treatments, resulting in a total of eight groups. The control groups (A1 and B1) had the tourniquet applied for 3 hours, while other groups had it used for 2 hours, followed by 5, 10, and 15-minute reperfusion intervals. Group A was sacrificed one hour post-deflation, and Group B was sacrificed on day 14. Malondialdehyde (MDA) level and muscle histology were analysed using one-way ANOVA.

Results In group A, significant difference was found between the 10 and 15-minute reperfusion intervals. In group B, the 10-minute reperfusion interval showed the most favourable outcome, with a 42.63% reduction in injury for group A and a 32.27% reduction for group B. Significant differences in MDA level was found between the control and reperfusion groups in both groups A and B.

Conclusion The 10-minute reperfusion interval effectively reduces ischemic reperfusion injury in muscle tissue, as indicated by lower MDA level and less muscle damage. This interval optimally restores aerobic metabolism and prevents excessive reactive oxygen species (ROS) production.

Author Contributions

Conceptualization, A.S.U.; Data curation, A.S.U.; Formal Analysis, A.S.U.; Project administration, A.S.U.; Writing – original draft, A.S.U.; Methodology, T.E.C.J.H.; Supervision, T.E.C.J.H.; Validation, T.E.C.J.H.; Writing – review & editing, T.E.C.J.H. All authors have read and agreed to the published version of the manuscript.

Citation

Funding Statement

No specific funding was received for this study.

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