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Extended Ex Vivo Normothermic Preservation of Fasciocutaneous Flaps
Jacob Lammers, DO, Brian Figueroa, MD, Mazen Al-Malak, MD, Ying Ku, DO, Lianne Mulvihill, MD, Diane Jo, MA, Ryan Khalaf, BS, R'ay Fodor, BA & Sc, Jose Reyes, BS, Abigail Meyes BS, Varun Kopparthy, PhD, Francis Papay, MD, Antonio Rampazzo, MD, PhD, Bahar Bassiri Gharb, MD, PhD
Cleveland Clinic Foundation
2023-01-31
Presenter: Jacob Lammers DO
Affidavit:
The information presented herein is a comparison of extended ex vivo perfusion. The resident presenting assumed the lead role on the 24 hour group and used the results of the 12 hour group to compare (which were done before his arrival to CCF). He was responsible for assisting and ensuring experimental quality, data collection/evaluation and abstract authorship.
Director Name: Bahar Bassiri Gharb MD Phd
Author Category: Other Specialty Resident
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Ex vivo normothermic perfusion (EVNP) extends the ischemia time for soft tissue flaps. We hypothesized that extended EVNP of flaps for 24-hour was feasible and outcomes were equivalent to 12-hour preservation.
Eighteen superior epigastric artery flaps were procured from Yorkshire pigs. Flaps were preserved by EVNP for 12 (PFP12; n=5) and 24 hours (PFP24; n=4). Contralateral flaps were preserved at 4°C as static cold storage controls (SCS;(n=9). Outcome measures, including perfusate dynamics, flap temperature, gases, metabolites, electrolytes, and flap weight, were monitored and evaluated. Indocyanine Green (ICG) angiography was utilized to analyze skin perfusion before division of the pedicle and at perfusion endpoint. Image analysis was performed using MATLAB® software to obtain contours of pixel intensity regions. Percent pixel above 200 intensity were computed to determine the ratio of the area of bright ICG regions to the total flap area.
Warm ischemia time was 15.7±5.2 min for EVNP12 and 13.50±7.05 min for EVNP24 (p=0.42). Flap temperature was 29.0±1.9 °C and 28.15±2.06 °C for EVNP12 and EVNP 24 (p= 0.84), respectively. Arterial perfusate pressures, arterial PaO2, lactate, and pH were not significantly different between groups. Additionally, there was no significant difference in sodium and potassium between groups. Percent weight change increased over time in both groups without significant differences (p=0.99). ICG angiography fluorescence scores were not significantly different between groups (p=0.23).
EVNP can preserve soft tissue flaps for 24 hours. Outcome at 24 hours were not significantly different from 12 hours.
