Department of Plastic, Reconstructive, and Hand Surgery, Bern University Hospital, Inselspital, Bern, Switzerland.
J Surg Res. 2011 Nov;171(1):291-9. doi: 10.1016/j.jss.2010.01.040. Epub 2010 Feb 21.
Successful extremity transplantations and replantations have to be performed within 6 h of amputation to avoid irreversible tissue loss. This study investigates ex vivo the technical feasibility and the limb preservation potential of extracorporeal whole blood perfusion in a porcine model.
Forelimbs of eight large white pigs were divided into paired groups: I perfusion group, II contralateral cold ischemia controls. In group I axillary arteries and veins were cannulated and perfusion with anticoagulated autologous blood was performed for 12 h; O(2), CO(2), Hb, lactate, potassium, pH, and muscle contractility were monitored. Tissue biopsies were examined by histology and immunofluorescence. Group II was stored at 4°C.
Continuous limb perfusion could be performed in all extremities of group I for 12 h. pH was maintained normal and potassium controlled with insulin and glucose. Lactate levels increased initially during perfusion due to the lack of a metabolizing liver. Muscle stimulation was possible throughout the entire perfusion, whereas a complete loss of response was noted in cold ischemia controls. Minor tissue damage was observed histologically and by immunofluorescence in group I, whereas the samples of group II were apparently preserved with the exception of a loss of endothelial heparan sulfate.
The tissue preserving potential and the feasibility of extremity perfusion using common extracorporeal blood circulation techniques was demonstrated in this ex vivo study. The results encourage further investigations in prolonged perfusion followed by limb replantation. This approach harbors promising clinical potential for extremity preservation in extremity transplantation and replantation.
成功的肢体移植和再植必须在离断后 6 小时内进行，以避免组织不可逆转的损失。本研究在猪模型中体外研究了全血灌流的技术可行性和肢体保存潜力。
将 8 头大白猪的前肢分为两组：I 组灌注组，II 组对侧冷缺血对照组。在 I 组中，腋动静脉插管，用抗凝自体血灌注 12 小时；监测 O(2)、CO(2)、Hb、乳酸、钾、pH 值和肌肉收缩力。组织活检通过组织学和免疫荧光检查。II 组在 4°C 下保存。
I 组所有肢体均可连续 12 小时进行肢体灌注。pH 值保持正常，钾通过胰岛素和葡萄糖控制。由于缺乏代谢肝脏，灌注初期乳酸水平升高。整个灌注过程中肌肉刺激都是可能的，而冷缺血对照组则完全失去反应。I 组的组织学和免疫荧光检查显示轻微的组织损伤，而 II 组的样本除了内皮肝素硫酸酯丢失外，明显保存完好。
本实验体外研究表明，使用常见的体外血液循环技术进行肢体灌注具有组织保存潜力和可行性。结果鼓励进一步研究延长灌注后肢体再植。这种方法为肢体移植和再植中的肢体保存提供了有前景的临床潜力。
