The Effect of Tourniquet Reperfusion Interval on MDA Levels and Skeletal Muscle Damage in the Treatment of Long Bone Fractures

Abstract

Background: Tourniquets are often used to assist hemostasis during surgery, even if they cause complications. Blood circulation return leads to ischemic reperfusion injury. Post-tourniquet syndromes, such as pain, swelling, and muscle weakness, occur up to six weeks after surgery. Thus, it is necessary to investigate the duration of reperfusion intervals to prevent ischemic reperfusion injury, specifically to muscle tissue.

Method: An experimental study using 48 male white rats (Rattus norvegicus) deliberately fractured in the tibial bone. The rats were divided into two treatment groups, A and B, each receiving four treatments. So, there were eight groups in total. In the control group, both A1 and B1, the tourniquet was installed using orthodontic rubber for 3 hours, while for the others for 2 hours, it was deflated for 5, 10, and 15 minutes, respectively, then the tourniquet was reattached for 1 hour. Group A was sacrificed 1 hour after tourniquet deflation and then checked for MDA levels and muscle histology. In group B, it was done on day 14. Data results were analyzed using one-way ANOVA.

Result: In group A, there was a significant difference between the ten and 15-minute groups. In group B, there was a significant difference between groups; the optimal decrease in PI occurred in the 10-minute reperfusion interval treatment, which was 42.63% for group A and 32.27 % for group B. Significant differences existed between the control and reperfusion interval groups in measuring MDA levels in groups A and B.

Conclusion: The reperfusion interval can reduce the incidence of ischemic reperfusion injury in the muscle organ at the distal tourniquet, characterized by MDA levels and a percentage of muscle tissue injury. The 10-minute reperfusion interval is the most effective in restoring aerobic metabolism and preventing excessive ROS production.