Plastic Surgery Department, Cleveland Clinic, Cleveland, Ohio.
General Surgery Department, Cleveland Clinic, Cleveland, Ohio.
Microsurgery. 2018 Feb;38(2):185-194. doi: 10.1002/micr.30252. Epub 2017 Oct 9.
Ischemia time represents a significant limitation for successful extremity transplantation because of the rapid deterioration of ischemic muscle. Normothermic ex-situ preservation is an emergent method to prolong the organ viability following procurement, by replicating the physiologic conditions. The aim of this study was to develop an ex-situ normothermic limb perfusion system to preserve the viability and function of porcine limbs for 12 hours following procurement.
A total of 18 swine limbs were perfused. Thirteen limbs were used to develop the perfusion protocol. Five limbs were perfused according to the optimized protocol. These limbs were perfused at 39°C for twelve hours using an oxygenated colloid solution containing red blood cells. Glucose and electrolytes were kept within physiologic range by partial perfusate exchange. Limb specific perfusion quality was assessed by muscle contractility upon electrical nerve stimulation, compartment pressure, creatine kinase (CK) and myoglobin concentrations, tissue oxygen saturation (near infrared spectroscopy), indocyanine green angiography, and infrared radiation by thermographic imaging.
The last five limbs reached the 12 hours' perfusion target maintaining normal compartment pressure (16.4 ± 8.20 mmHg), minimal weight increase (0.54 ± 7.35%), and mean muscle temperature of 33.6 ± 1.67°C. Myoglobin and CK concentrations were 875 ± 291.4 ng/mL, and 53344 ± 14850.34 U/L, respectively, at the end of perfusion. Muscle contraction was present in all limbs until cessation of perfusion. Differences in uniformity and quality of distal perfusion were identified with thermography and angiography imaging at 12 hours of perfusion.
Ex-situ normothermic limb perfusion preserves swine limb physiology and function for at least 12 hours.
由于缺血肌肉的迅速恶化，缺血时间成为成功进行肢体移植的一个重要限制因素。常温离体保存是一种通过复制生理条件来延长器官活力的紧急方法。本研究的目的是开发一种离体常温肢体灌注系统，以在采集后 12 小时内保持猪肢体的活力和功能。
共灌注了 18 只猪的肢体。13 只肢体用于开发灌注方案。根据优化方案对 5 只肢体进行了灌注。这些肢体在 39°C 下用含有红细胞的氧合胶体溶液灌注 12 小时。通过部分灌注液交换将葡萄糖和电解质保持在生理范围内。通过电神经刺激时肌肉收缩力、间隔压、肌酸激酶 (CK) 和肌红蛋白浓度、组织氧饱和度 (近红外光谱)、吲哚菁绿血管造影和通过热成像的红外辐射来评估肢体特定的灌注质量。
最后 5 只肢体达到了 12 小时的灌注目标，保持正常的间隔压 (16.4 ± 8.20mmHg)、最小的体重增加 (0.54 ± 7.35%) 和平均肌肉温度 33.6 ± 1.67°C。灌注结束时肌红蛋白和 CK 浓度分别为 875 ± 291.4ng/mL 和 53344 ± 14850.34U/L。在灌注停止前，所有肢体的肌肉收缩都存在。通过热成像和血管造影成像在 12 小时的灌注中发现了远端灌注均匀性和质量的差异。
离体常温肢体灌注可至少保存猪肢体的生理学和功能 12 小时。
