American Association of Plastic Surgeons

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Normothermic Ex-Situ Perfusion of Human Upper Extremity
Carlos X. Ordenana, Medical Doctor, Vahe Fahradyan, MD, Majid Rezaei, DDS MS, Edoardo Dalla Pozza, MD, Maria Madajka, PhD, Francis Papay, MD, Antonio Rampazzo, MD PhD, Bahar Bassiri, MD PhD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE:
Ischemia-reperfusion injury remains one of the major limiting factors for both replantation and vascularized composite allotransplantation. Normothermic ex-vivo perfusion (NEVP) is a novel approach that prolongs the viability of the organs by maintaining the physiologic metabolism and avoiding the deleterious effects of both hypoxia and cooling. This study aimed to assess the effectiveness of NEVP in preserving the viability and function of amputated limbs.
METHODS:
Fourteen human upper extremities were procured from consenting organ donors. Seven limbs were perfused using an oxygenated colloid solution containing pRBCs at 38C, until the vascular resistance increased above 250mmHg.min/L. Seven limbs were preserved at 4C as control. Electrolytes were kept within physiologic range by perfusate exchanges. Limb viability was assessed by muscle contractility, tissue oxygen saturation, creatine kinase (CK) and myoglobin concentrations, indocyanine green (ICG) angiography, thermography and histology.
RESULTS:
Perfused arms retained physiological parameters and function up to 50 hours with a final weight change of -4% 10%, mean muscle temperature of 35.21 1.29C, and tissue oxygen saturation 92.2510.02%. Average final values of myoglobin and CK were 31863.3318621.31ng/mL, and 31,63012544U/L. Thermography and ICG angiography depicted uniform peripheral perfusion throughout the experiments. Electrical stimulation of median, ulnar and radial nerves displayed no initial muscle contraction, however, muscle contraction recovered gradually. In the control group, no contraction was identified.
CONCLUSION:
NEVP of human upper extremities showed potential in overcoming the present standard preservation method (cold storage) improving ischemia time, envisioning a radical change in the management of traumatic amputations and upper extremity transplantation.


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