Article
Acellular hypothermic extracorporeal perfusion extends allowable ischemia time in a porcine whole limb replantation model
Extrakorporale azelluläre Maschinenperfusion verlängert mögliche Ischämiezeit in einem porkinen Extremitätenreplantationsmodell
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Published: | September 27, 2016 |
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Background: One of the major challenges in traumatic amputations (TA) is the need to maintain ischemia time brief (4-6h) in order to avoid ischemic damage and enable successful replantation. Our inability to meet this challenge often leads to traumatic limb loss, which has a considerable detrimental impact on the quality of life of patients.
Methods: Our team built a portable extracorporeal membrane oxygenator device for the perfusion of amputated extremities with oxygenated acellular solution under controlled parameters. We amputated forelimbs of Yorkshire pigs, perfused them ex vivo with acellular Perfadex® solution for 12 hours at 10°C in our device and subsequently replanted them into the host animal. We used limbs stored on ice slurry for 4 hours before replantation as our control group.
Results: Clinical observation and histopathological evaluation both demonstrated that there was less morbidity and less tissue damage to the cells during preservation and after replantation in the perfusion group when compared to the standard of care. Significant differences in blood markers of muscle damage and tissue cytokine levels underscored these findings.
Conclusion: We demonstrated the feasibility and superiority of ex vivo hypothermic oxygenated machine perfusion for preservation of amputated limbs over conventional static cold storage and herewith a substantial extension of the allowable ischemia time for replantation after traumatic amputations. This approach could also be applied to the field of transplantation expanding the potential pool of viable donor vascularized composite allografts.