Artikel
Mobile perfusion device for extracorporeal limb preservation in replantation and transplantation
Suche in Medline nach
Autoren
-
Maximilian Kückelhaus
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, USA; Bochum, Deutschland
-
Sebastian Fischer
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, USA; BG Klinik Ludwigshafen, Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische und Handchirurgie der Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Deutschland
-
Geoffroy Sisk
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, USA
-
Ericka Bueno
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, USA
-
Tobias Hirsch
- BG Universitätsklinik Bergmannsheil , Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, Bochum, Deutschland
-
Marcus Lehnhardt
- Bochum, Deutschland
-
Bohdan Pomahac
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, USA
| Veröffentlicht: | 3. September 2014 |
|---|
Gliederung
Text
Introduction: Traumatic amputation (TA) is the second leading cause of limb loss in the US and often occurs in rural settings or military conflicts. Extension of allowable ischemia time is critically important to enhance the chances of successful replantation. Vascularized Composite Allotransplantation (VCA) has become a clinical reality to perform restoration of extremities if replantation is not possible. Extending the allowable ischemia time can increase the donor radius and therefore provide better access to suitable donors. Extracorporeal perfusion (EP) has been successfully adapted into portable modules that are presently used to help support patients in active cardiopulmonary failure and to perfuse organs in transit from donor to recipient sites.
Methods: We built a portable EP system for perfusion of isolated porcine hindlimbs in order to extend allowable ischemia time for re- and transplantation. For 12 hours following amputation, porcine hindlimbs were perfused with oxygenated organ preservation solution. Arterial and venous perfusion solution was analyzed hourly during perfusion. Muscle and skin biopsies where performed every 2 hours. Quantitative histological evaluation of muscle tissue was performed and compared to isolated limbs preserved in the conventional manner, i.e. standard cold preservation (ice).
Results: The defined arterial pressure of 40 mmHg provided a sufficient flow rate. Analysis of the perfusion solution enabled us to keep the pH within a physiologic range. Potassium increases could be observed in arterial and venous perfusion solution samples. Glucose levels where higher in arterial than in venous samples. Swelling was effectively prevented by methylpredisolone. Quantitative histological evaluation did not show significant differences in nuclei centralization or fiber shape between perfused and control muscle tissue.
Discussion: Our portable EP system enables us to reliably perform 12 h of isolated limb perfusion at defined arterial pressure and temperature. The next aim will be the successful replantation and subsequent transplantation of perfused limbs to assess the potential to decrease ischemia-reperfusion injury and therefore extend the allowable ischemia time. If successful, our approach will provide wider access for surgical replantation, transplantation selective graft treatment.
