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Ex-situ Normothermic Perfusion of Human Upper Extremity
Vahe Fahradyan, MD, Edoardo Dalla Pozza, MD, Maria Madajka, PhD, Kihyun Cho, MD, Nadeera Dawlagala, MD, Eliana Duraes, MD, Hirsh Shah, Carlos Ordenana, MD, Sayf Al-deen Said, MD, Frank Papay, MD, Antonio Rampazzo, MD, PhD, Bahar Bassiri Gharb, MD, PhD
Cleveland Clinic
2018-01-30
Presenter: Vahe Fahradyan, MD
Affidavit:
Vahe Fahradyan was involved in all steps of this study.
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Hand
Purpose: Ischemia time remains a significant limiting factor for successful extremity replantation and transplantation. Compared to the cold storage normothermic ex-situ perfusion is a novel method of a limb preservation by maintaining physiologic cellular metabolism avoiding the deleterious effects of hypoxia and cooling. The purpose of our study was to establish the efficacy of normothermic ex-situ perfusion in preserving viability and function of human upper extremities.
Methods: Six upper extremities were procured from brain-dead organ donors. Three limbs were perfused using an oxygenated colloid solution at 38°C containing PRBC, plasma, and albumin. Three were preserved at 4°C as a control. Electrolytes were kept within physiologic range by partial perfusate exchanges. Limb viability was assessed by muscle contractility, compartment pressure, tissue oxygen saturation, creatine kinase(CK) and myoglobin concentrations, indocyanine green (ICG)angiography and thermography.
Results: Perfused arms retained physiological parameters and function up to 48 hours with a final weight increase of 8.33%±0.07, compartment pressure 32.33±8.5mmHg, mean muscle temperature of 35.5±0.61oC, and tissue oxygen saturation 90.44%±11.2. Average values of final myoglobin and CK concentrations were 31863.33±18621.31ng/mL, and 68456.67±32236.09U/L. Thermography and ICG angiography depicted uniform peripheral perfusion throughout the experiment. Electrical stimulation of median, ulnar and radial nerves displayed no muscle contraction at the beginning, however, it recovered gradually and preserved until the end of perfusion
Conclusion: Ex-situ normothermic limb perfusion shows potential in overcoming the present standard of care (cold preservation) improving ischemia time for large segments and envisioning a radical change in the management of traumatic amputations and upper extremity transplantation.
