Successful Long-term Extracorporeal Perfusion of Free Musculocutaneous Flaps in a Porcine Model

Kruit, Anne Sophie; Schreinemachers, Marie-Claire J.M.; Koers, Erik; Zegers, Her; Hummelink, Stefan; Ulrich, Dietmar

doi:10.1016/j.jss.2018.09.076

Cited by 19 publications

(26 citation statements)

References 36 publications

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“…A bladder catheter was inserted and continuous arterial blood pressure monitoring was possible through a femoral artery line. This experiment followed a mid‐thermic perfusion protocol and used a commercially available acellular solution (University of Wisconsin machine perfusion solution; UW‐mp), based on positive results in previous experiments with musculocutaneous flap replantation [18,19]. Primary outcomes were muscle contraction upon nerve stimulation and muscle histology.…”

Section: Methodsmentioning

confidence: 99%

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Successful 18‐h acellular extracorporeal perfusion and replantation of porcine limbs ‐ Histology versus nerve stimulation

et al. 2021

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Summary The current standard for composite tissue preservation is static cold storage (SCS) and is limited to 6 h until irreversible muscle damage occurs. Extracorporeal perfusion (ECP) is a promising technique for prolonged preservation, however, functional results have been scarcely researched. This article assessed neuromuscular function and compared results to histological alterations to predict muscle damage after ECP. Forelimbs of twelve Dutch landrace pigs were amputated and preserved by 4 h SCS at 4–6 °C (n = 6) or 18 h mid‐thermic ECP with University of Wisconsin solution (n = 6). Limbs were replanted and observed for 12 h. Sham surgery was performed on contralateral forelimbs (n = 12). Histology analysis scored four subgroups representing different alterations (higher score equals more damage). Muscle contraction after median nerve stimulation was comparable between ECP, SCS, and sham limbs (P = 0.193). Histology scores were higher in ECP limbs compared to SCS limbs (4.8 vs. 1.5, P = 0.013). This was mainly based on more oedema in these limbs. In‐vivo muscle contraction was well preserved after 18 h ECP compared to short SCS, although histology seemed inferior in this group. Histology, therefore, did not correlate to muscle function at 12 h after replantation. This leads to the question whether histology or neuromuscular function is the best predictor for transplant success.

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Section: Methodsmentioning

confidence: 99%

“…Six limbs were attached to the extracorporeal perfusion set‐up and continuously perfused for 18 h with 1 l of oxygenated UW‐mp solution (perfusion group, Fig. 1) [18]. To reduce oedema, 40 mg methylprednisolone was added to the solution.…”

Section: Methodsmentioning

confidence: 99%

Successful 18‐h acellular extracorporeal perfusion and replantation of porcine limbs ‐ Histology versus nerve stimulation

et al. 2021

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“…Kueckelhaus et al and Kruit et al oxygenate the acellular perfusates (Perfadex and Histidine-Tryptophan-Ketoglutarate (HTK), respectively) during HMP. 25,34 Other groups conducting HMP have reported comparable results without the need to add oxygen to their perfusates. 35 The role of oxygenation in HMP is still the subject of investigations.…”

Section: Oxygenationmentioning

confidence: 97%

“…However, the need for oxygen persists because the metabolic rate remains at levels estimated around 10% and several studies have shown the benefits of oxygenation during HMP. Kueckelhaus et al and Kruit et al oxygenate the acellular perfusates (Perfadex and Histidine‐Tryptophan‐Ketoglutarate (HTK), respectively) during HMP . Other groups conducting HMP have reported comparable results without the need to add oxygen to their perfusates .…”

Section: Oxygenationmentioning

confidence: 99%

“…Perfusates used in HMP are all acellular in nature. Solutions like University of Wisconsin's, 34,43 Perfadex, 24,25 modified Perfadex, 35 histidine-tryptophan-ketoglutarate (HTK), 30,34,43 or STEEN's 30,44 have been the solution of choice. As described earlier, an oncotic agent, critical nutrients, anti-inflammatory agents, antibiotics, and electrolytes were other components of HMP perfusates.…”

Section: Perfusatementioning

confidence: 99%

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