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Acellular Hypothermic Extracorporeal Perfusion Extends Allowable Ischemia Time in a Porcine Whole Limb Replantation Model

Kueckelhaus, Maximilian M.D.; Dermietzel, Alexander M.D.; Alhefzi, Muayyad M.D.; Aycart, Mario A. M.D.; Fischer, Sebastian M.D.; Krezdorn, Nicco M.D.; Wo, Luccie M.Sc.; Maarouf, Omar H. M.D., Ph.D.; Riella, Leonardo V. M.D., Ph.D.; Abdi, Reza M.D., Ph.D.; Bueno, Ericka M. Ph.D.; Pomahac, Bohdan M.D.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 922e–932e
doi: 10.1097/PRS.0000000000003208
Experimental: Original Articles

Background: One of the major challenges in traumatic amputation is the need to keep ischemia time brief (4 to 6 hours) to avoid ischemic damage and enable successful replantation. The current 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: The authors’ team built a portable extracorporeal membrane oxygenator device for the perfusion of amputated extremities with oxygenated acellular solution under controlled parameters. The authors amputated forelimbs of Yorkshire pigs, perfused them ex vivo with acellular Perfadex solution for 12 hours at 10°C in their device, and subsequently replanted them into the host animal. The authors used limbs stored on ice slurry for 4 hours before replantation as their control group.

Results: Clinical observation and histopathologic evaluation both demonstrated that there was less morbidity and less tissue damage to the cells during preservation and after replantation in the perfusion group compared with the standard of care. Significant differences in blood markers of muscle damage and tissue cytokine levels underscored these findings.

Conclusions: The authors 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 amputation. This approach could also be applied to the field of transplantation, expanding the potential pool of viable donor vascularized composite allografts.

Boston, Mass.; and Bochum and Heidelberg, Germany

From the Department of Surgery, Division of Plastic Surgery, and the Transplant Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School; the Department of Plastic Surgery, Burn Center, Sarcoma Reference Center, BG University Hospital Bergmannsheil, Ruhr University Bochum; the Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg.

Received for publication April 12, 2016; accepted July 26, 2016.

The first two authors contributed equally to the study.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Bohdan Pomahac, M.D., Center for Facial Restoration, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, Mass. 02115, bpomahac@partners.org

©2017American Society of Plastic Surgeons