A Mobile Extracorporeal Extremity Salvage System for Replantation and Transplantation

Abstract

We have designed and built a small, mobile perfusion device that is operational and that more closely mimics the normal physiological environment when compared with the current standard of preservation in ice slurry. This project may have far-reaching implications for the treatment of limb loss through replantation and transplantation.

Developing a protocol for normothermic ex‐situ limb perfusion

“…In the hypothermic range, Kueckelhaus et al perfused porcine limbs at 10°C with an acellular solution, reporting an average weight gain of 44.06% and loss of muscle contraction after 3 hours (Kueckelhaus, Fischer, & Sisk, ). Another group confirmed similar weight gain after 24‐hour perfusion of canine limbs in hypothermic conditions, with perfusates consisting of whole blood (27.5% increase), colloids (20.6% increase) and crystalloids (51.5% increase) (Domingo‐Pech, Garriga, & Toran, 1991).…”

Machine preservation of extremities

“…Based on reduction in markers of cellular injury, inflammation, and better tissue integrity, they concluded that porcine forelimbs could be optimally preserved via HMP. However, Kueckelhaus et al showed 44% weight gain in their HMP of porcine hindlimbs after 12 hours . In another experiment, they replanted forelimbs of Yorkshire pigs after 12 hours of HMP .…”

“…However, Kueckelhaus et al showed 44% weight gain in their HMP of porcine hindlimbs after 12 hours. 24 In another experiment, they replanted forelimbs of Yorkshire pigs after 12 hours of HMP. 25 They noticed a weight increase of 10% between the start and end of perfusion.…”

“…Perfusates used in HMP are all acellular in nature. Solutions like University of Wisconsin's, 34,43 Perfadex, 24,25 modified Perfadex, 35 histidine-tryptophan-ketoglutarate (HTK), 30,34,43 or STEEN's 30,44 have been the solution of choice. As described earlier, an oncotic agent, critical nutrients, anti-inflammatory agents, antibiotics, and electrolytes were other components of HMP perfusates.…”

Extended ex vivo normothermic perfusion for preservation of vascularized composite allografts

“…Domingo-Pech et al confirmed similar weight gain after 24-hour perfusion of canine limbs in hypothermic conditions, with perfusates consisting of whole blood (27.5% increase), colloids (20.6% increase) and crystalloids (51.5% increase). 26 Kueckelhaus et al 27 perfused porcine hindlimbs at 10°C for 12 hours with an acellular modified Perfadex solution reporting a 44.06% weight gain. Muscle contraction was lost after 3 hours.…”