Kruit Anne Sophie, Winters Harm, van Luijk Judith, Schreinemachers Marie-Claire J M, Ulrich Dietmar J O
Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
J Surg Res. 2018 Jul;227:7-16. doi: 10.1016/j.jss.2018.01.023. Epub 2018 Mar 2.
Extracorporeal perfusion is a promising new technique for prolonged preservation of free flaps and extremities; however, uncertainties on perfusion settings and efficacy still exist. No overview of literature is currently available. This review systematically appraised available evidence comparing extracorporeal perfusion to static storage.
An electronic systematic search was performed on June 12, 2016, in MEDLINE and EMBASE. Articles were included when evaluating the effect of extracorporeal perfusion of free flaps or extremities compared to that of a control group. Two independent researchers conducted the selection process, critical appraisal, and data extraction.
Of 3485 articles screened, 18 articles were included for further analyzation. One article studied discarded human tissue; others were studies conducted on rats, pigs, or dogs. Perfusion periods varied from 1 h to 10 d; eight articles also described replantation. Risk of bias was generally scored high; none of the articles was excluded based on these scores. Tissue vitality showed overall better results in the perfused groups, more pronounced when perfusing over 6 h. The development of edema was a broadly described side effect of perfusion.
Although tissue vitality outcomes seem to favor extracorporeal perfusion, this is difficult to objectify because of large heterogeneity and poor quality of the available evidence. Future research should focus on validating outcome measures, edema prevention, perfusion settings, and maximum perfusion time for safe replantation and be preferably performed on large animals to increase translation to clinical settings.
体外灌注是一种用于长时间保存游离皮瓣和肢体的有前景的新技术；然而，灌注设置和效果仍存在不确定性。目前尚无文献综述。本综述系统评价了比较体外灌注与静态保存的现有证据。
2016年6月12日在MEDLINE和EMBASE上进行了电子系统检索。纳入评估游离皮瓣或肢体体外灌注与对照组效果比较的文章。由两名独立研究人员进行筛选过程、批判性评价和数据提取。
在筛选的3485篇文章中，18篇文章纳入进一步分析。1篇文章研究废弃人体组织；其他文章是在大鼠、猪或狗身上进行的研究。灌注时间从1小时到10天不等；8篇文章还描述了再植。偏倚风险总体评分较高；没有文章基于这些评分被排除。在灌注组中组织活力总体显示出更好的结果，在灌注超过6小时时更为明显。水肿的发生是灌注广泛描述的副作用。
尽管组织活力结果似乎有利于体外灌注，但由于存在较大异质性和现有证据质量较差，难以客观化。未来的研究应侧重于验证结果指标、预防水肿、灌注设置以及安全再植的最大灌注时间，并且最好在大型动物上进行以增加向临床应用的转化。
