<< Back to the abstract archive
Extended Normothermic Ex-Situ Limb Perfusion Preserves Limb Viability and Function up to 44 hours
Edoardo Dalla Pozza, MD (1),
Eliana Duraes, MD,MS,MBA (1),
Maria Madajka, Ph.D (1),
Kihyun Cho, MD (1),
Nadeera Dawlagala, MD (1)
Russel Frautschi, BS (1),
Vahe Fahradyan, MD (1),
Hirsh Shah, BS (1),
Cagri Cakmakoglu, MD (1),
Cristiano Quintini, MD (2),
Francis Papay, MD FACS (1),
Antonio Rampazzo, MD Ph.D (1), Bahar Bassiri Gharb, MD Ph.D (1).
(1) Plastic Surgery Department, Cleveland Clinic, Cleveland, OH, United States and (2) General Surge
2017-02-15
Presenter: Edoardo Dalla Pozza
Affidavit:
Dr. Edoardo Dalla Pozza has significantly contributed to this research project.
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: Compared to the cold storage, normothermic ex-situ perfusion is a novel approach to prolong viability of amputated limbs by maintaining physiologic cellular metabolism, avoiding the deleterious effects of hypoxia and cooling. This study aims to develop an ex-situ normothermic limb perfusion system to preserve the viability and function of amputated limbs for over 24 hours.
Methods: A total of 23 swine limbs were perfused using an oxygenated colloid solution at 38°C containing washed RBCs. The first 13 limbs were used to optimize the perfusion protocol. The subsequent 5 limbs (Group A) were perfused for 12 hours and the following 5 (Group B) as long as muscle contractility/peripheral perfusion were present. Electrolytes were balanced by partial perfusate exchanges. Limb viability was compared in the 2 groups by muscle contractility, compartment pressure, tissue oxygen saturation, indocyanine green (ICG)-angiography and thermography.
Results: Perfused limbs were able to retain physiological parameters and function for 12 hours in group A and up to 44 (24-44) hours in group B. Limbs in group A had lower final weight increase (0.54%±0.07 VS 14.11%±16.27) (p=0.008) and compartment pressure (16.23±7.10 VS 24.75±7.79) (p=0.175). Thermography and tissue oxygen saturation had significantly higher values in group B (35.37±0.69°C VS 33±1.44°C (p0.01) and 69.31±9.3% VS 58.69±8.4% (p=0.048)). Contractility and ICG-angiography were comparable in the groups.
Conclusions: Our results suggest that limbs with shorter ex-situ perfusion retain better physiologic parameters at the end-point. However, the continuous optimization of the protocol allowed to maintain limb's function and peripheral perfusion up to 44 hours.
