Extracorporeal Free Flap Perfusion Using Extracorporeal Membrane Oxygenation Device

Öztürk, Mesut; Aksan, Tolga; Özçelık, İsmail Bülent; Ertekin, Cengiz; Akcakoyunlu, Bahadir; Özkanli, Sıdıka Şeyma; Tezcan, Mustafa

doi:10.1097/sap.0000000000002014

Cited by 6 publications

(1 citation statement)

References 25 publications

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“…Performing machine perfusion of fasciocutaneous flaps appears to be safe for reconstructive surgery applications, and this was the focus of our study because of the potential for immediate implementation in plastic surgery [2,51,52]. Ozturk et al, described the perfusion of five freshly harvested DIEP flaps on patients undergoing abdominoplasty [53]. They used fresh whole blood and were able to keep the flaps perfused for 4 to 5 days.…”

Section: Discussionmentioning

confidence: 99%

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Berkane,

Lellouch,

Goudot

et al. 2023

Bioengineering

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Machine perfusion has developed rapidly since its first use in solid organ transplantation. Likewise, reconstructive surgery has kept pace, and ex vivo perfusion appears as a new trend in vascularized composite allotransplants preservation. In autologous reconstruction, fasciocutaneous flaps are now the gold standard due to their low morbidity (muscle sparing) and favorable functional and cosmetic results. However, failures still occasionally arise due to difficulties encountered with the vessels during free flap transfer. The development of machine perfusion procedures would make it possible to temporarily substitute or even avoid microsurgical anastomoses in certain complex cases. We performed oxygenated acellular sub-normothermic perfusions of fasciocutaneous flaps for 24 and 48 h in a porcine model and compared continuous and intermittent perfusion regimens. The monitored metrics included vascular resistance, edema, arteriovenous oxygen gas differentials, and metabolic parameters. A final histological assessment was performed. Porcine flaps which underwent successful oxygenated perfusion showed minimal or no signs of cell necrosis at the end of the perfusion. Intermittent perfusion allowed overall better results to be obtained at 24 h and extended perfusion duration. This work provides a strong foundation for further research and could lead to new and reliable reconstructive techniques.

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Section: Discussionmentioning

confidence: 99%

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Berkane,

Lellouch,

Goudot

et al. 2023

Bioengineering

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Machine Perfusion Deters Ischemia-Related Derangement of a Rodent Free Flap: Development of a Model

Orizondo,

Bengur,

Komatsu

et al. 2024

Journal of Surgical Research

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A Guide to the Implementation and Design of Ex Vivo Perfusion Machines for Vascularized Composite Allotransplantation

Muss,

Loftin,

Zamore

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Ex vivo machine perfusion (EVMP) is a versatile platform utilized in vascularized composite allotransplantation (VCA) to prolong preservation, salvage tissue, and evaluate graft viability. However, there is no consensus on best practices for VCA. This article discusses the common components, modifications, and considerations necessary for a successful VCA perfusion. Methods: A systematic literature review was performed in several databases (PubMed, Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov) to identify articles published on VCA EVMP (face, limb, abdominal wall, uterus, penis, and free flaps) before August 2022. Graft type and animal model, general perfusion parameters, core components of the circuit, and optional components for enhanced monitoring were extracted from the articles. Results: A total of 1370 articles were screened, and 46 articles met inclusion criteria. Most articles (84.8%) were published in the last 10 years. Pigs were the main model used, but 10 protocols used human grafts. Free flaps were the most common graft type (41.3%), then upper extremities/forelimbs (28.3%), uteruses (17.4%), and hindlimbs (13.0%). Postperfusion replantation occurred in 15.2% of studies. Normothermic perfusion predominated (54.1%), followed by hypothermic (24.3%), and subnormothermic (21.6%). The majority of studies (87.0%) oxygenated their systems, most commonly with carbogen. Conclusions: EVMP is a rapidly growing area of research. Leveraging EVMP in VCA can optimize VCA procedures and allow for expansion into replantation, flap salvage, and other areas of plastic surgery. Currently, VCA EVMP is achieved through a variety of approaches, but standardization is necessary to advance this technology and attain clinical translation.

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Extracorporeal Free Flap Perfusion Using Extracorporeal Membrane Oxygenation Device

Cited by 6 publications

References 25 publications

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study

Machine Perfusion Deters Ischemia-Related Derangement of a Rodent Free Flap: Development of a Model

A Guide to the Implementation and Design of Ex Vivo Perfusion Machines for Vascularized Composite Allotransplantation

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