Transplantation Surgery and ResearchComposite Tissue PreservationDickey, Ryan M. MDa; Hembd, Austin S. MDa; Fruge, Seth MDa; Haddock, Nicholas T. MDa; Papas, Klearchos K. PhDb; Suszynski, Thomas M. MD, PhDaAuthor Information From the aDepartment of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX bDepartment of Surgery, Institute of Cellular Transplantation, University of Arizona, Tucson, AZ. Received June 11, 2019, and accepted for publication, after revision October 1, 2019. Conflicts of interest and sources of funding: T.M.S. and K.K.P. are co-inventors on an issued US patent regarding persufflation technology. The other authors have nothing to declare. Reprints: Thomas M Suszynski, MD, PhD, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235. E-mail: email@example.com. Online date: January 17, 2020 Annals of Plastic Surgery: June 2020 - Volume 84 - Issue 6 - p 711-716 doi: 10.1097/SAP.0000000000002194 Buy Metrics Abstract Composite tissue (CT) preservation is important to outcomes after replant or transplant. Since the first limb replant, the mainstay of preservation has been static cold storage with the amputated part being placed in moistened gauze over ice. Historically, the gold-standard in solid organ preservation has been static cold storage with specialized solution, but this has recently evolved in the last few decades to develop technologies such as machine perfusion and even persufflation. This review explores the impact of cooling and oxygenation on CT, summarizes the work done in the area of CT preservation, discusses lessons learned from our experience in solid organ preservation, and proposes future directions. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.