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Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 254-259

Can we use creatine kinase muscle type as a potential marker for muscle viability in mangled extremities? A preliminary evaluation of its applicability and a literature review

1 Department of Orthopaedics, PGIMER, Chandigarh, India
2 Department of Histopathology, PGIMER, Chandigarh, India

Correspondence Address:
Dr. Mandeep S Dhillon
Department of Orthopaedics, PGIMER, Sector-12, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_41_19

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Objectives: Increased expression of serum creatine kinase muscle type (CK-MM) in muscle overuse or injury has been documented in many situations. However, the expression of CK-MM and its correlation with the extent of traumatic damage to skeletal muscle tissue has not been explored. We studied the pattern of expression of CK-MM in substantially damaged muscle tissue and attempted to correlate its expression with the extent of muscle damage. Methods: At level 1 trauma center, 15 patients with mangled lower limb were prospectively evaluated. All patients underwent primary amputation (mangled extremity severity score ≥7) using specific criteria. Muscle tissue samples were obtained intraoperatively from 3 different zones (chosen arbitrarily based on clinical parameters of muscle viability, Zones A, B, and C) for all patients. Samples were evaluated by hematoxylin and eosin (H and E) staining and immunohistochemistry (IHC) staining with polyclonal CK-MM antibody. Results: H and E staining correlated with the clinical extent of muscle death in Zones A, B, and C; the percentage of viable muscle fibers was 6.7% in Zone A, 20% in Zone B, and 73% in Zone C. Least CK-MM expression was noted in muscle tissues on IHC in Zone A (most necrotic area) and most in Zone C (most viable area). The score developed by us corroborated with the extent of muscle damage and viability. Conclusion: IHC staining for CK-MM can be used as a definite biomarker of muscle integrity and can be used as an adjunct to clinical evaluation to help define limb viability as well as levels of amputation when that is required.

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