Special Section on Optical Diagnostic and Biophotonic Methods from Bench to Bedside

Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: near-infrared spectroscopy for the orthopedics setting

[+] Author Affiliations
Babak Shadgan

University of British Columbia Hospital, Unit 1B—Room F329, 2211 Wesbrook Mall, Vancouver, BC, V5Z 1L8, Canada

W. Darlene Reid

Vancouver Coastal Health Research Institute (VCHRI), Muscle Biophysics Laboratory and Department of Physical Therapy, 617–828 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada

R. Luke Harris

University of Northern British Columbia, School of Health Sciences and Northern Medical Program, T&L #10-3590, 3333 University Way, Prince George British Columbia, BC, V2N 4Z9, Canada

Siavash Jafari

University of British Columbia, School of Population & Public Health, Vancouver, BC, V6T 1Z3, Canada

Scott K. Powers

University of Florida, College of Health & Human Performance, Gainesville, Florida 32611-8208

Peter J. O’Brien

University of British Columbia, Division of Orthopaedic Trauma, Department of Orthopaedics, 110–828 West 10th Avenue, VCHRI, Vancouver, BC, V5Z 1L8, Canada

J. Biomed. Opt. 17(8), 081408 (May 21, 2012). doi:10.1117/1.JBO.17.8.081408
History: Received December 12, 2011; Revised April 4, 2012; Accepted April 10, 2012
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Abstract.  During orthopedic procedures, the tourniquets used to maintain bloodless surgical fields cause ischemia and then reperfusion (I/R), leading to oxidative muscle injury. Established methods exist neither for monitoring orthopedic I/R nor for predicting the extent of tourniquet-associated oxidative injury. To develop a predictive model for tourniquet-associated oxidative muscle injury, this study combined real-time near-infrared spectroscopy (NIRS) monitoring of I/R with Western blotting (WB) for oxidized proteins. We hypothesized strong correlations between NIRS-derived I/R indices and muscle protein oxidation. In 17 patients undergoing ankle fracture repair, a thigh tourniquet was inflated on the injured limb (300 mmHg). Using a continuous-wave (CW) NIRS setup, oxygenated (O2Hb), deoxygenated (HHb), and total (tHb) hemoglobin were monitored bilaterally (tourniquet versus control) in leg muscles. Leg muscle biopsies were collected unilaterally (tourniquet side) immediately after tourniquet inflation (pre) and before deflation (post). Average ischemia duration was 43.2±14.6min. In post-compared to pre-biopsies, muscle protein oxidation (quantified using WB) increased 172.3%±145.7% (P<0.0005). Changes in O2Hb and tHb were negatively correlated with protein oxidation (respectively: P=0.040, R2=0.25 and P=0.003, R2=0.58). Reoxygenation rate was positively correlated with protein oxidation (P=0.041, R2=0.25). These data indicate that using CW NIRS, it is possible to predict orthopedic tourniquet-associated muscle oxidative injury noninvasively.

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© 2012 Society of Photo-Optical Instrumentation Engineers

Citation

Babak Shadgan ; W. Darlene Reid ; R. Luke Harris ; Siavash Jafari ; Scott K. Powers, et al.
"Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: near-infrared spectroscopy for the orthopedics setting", J. Biomed. Opt. 17(8), 081408 (May 21, 2012). ; http://dx.doi.org/10.1117/1.JBO.17.8.081408


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