Ex-vivo oxygenated perfusion of free flaps during ischemia time: a feasibility study in a porcine model and preliminary results

Slater, Nicholas J.; Zegers, Her; Küsters, Benno; Beune, Thimpe; Swieten, Henri A. van; Ulrich, Dietmar

doi:10.1016/j.jss.2016.06.096

Cited by 25 publications

(18 citation statements)

References 7 publications

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“…Delivering hypothermic, sterile, pulsatile circulation decreases metabolic demand and is a well‐established method of organ preservation (Jochmans, O'Callaghan, Pirenne, & Ploeg, ). Hypothermic machine perfusion (HMP) has also been used in a number of case reports and small case series of extended ischemia time during free tissue transfer (Cooley et al, ; Jochmans et al, ; Slater et al, ; Taeger, Prabst, Beier, Meyer, & Horch, ). Additionally, HMP offers a window of opportunity in which to assess and treat the organ or flap.…”

Section: Discussionmentioning

confidence: 99%

“…The use of the kidney perfusion pump specifically does have some additional advantages over other perfusion systems. All previous free flap and replantation perfusion literature makes use of self‐built, non‐commercially available pumps (Cooley et al, ; Dragu et al, ; Fichter et al, ; Kueckelhaus et al, ; Liu et al, ; Slater et al, ; Taeger et al, ). These pumps can be difficult and also expensive to create, whereas kidney perfusion pumps are readily available at many transplant centers, or can be easily purchased.…”

Section: Discussionmentioning

confidence: 99%

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Using a kidney pump to perfuse a free filet flap for reconstruction after hemipelvectomy: A case report

et al. 2018

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Long ischemia times adversely affect free flap survival, and large muscle flaps are particularly vulnerable. Hypothermic machine perfusion (HMP) is a well-established method of organ preservation, and recent literature has detailed the use of HMP to extend free flap ischemia times, predominantly in the laboratory setting. One limitation in the study and adoption of free flap HMP has been the availability of standardized perfusion machinery, as thus far institutions have built their own devices. We present a case of a 75-year-old woman with dedifferentiated chondrosarcoma of her right proximal femur. She underwent a "spare parts" surgery using a filet flap from her lower leg. Due to an obligate long ischemia time between flap harvest and revascularization, a kidney transplant perfusion pump was used to flush and cool the flap. After completion of the disarticulation, free tissue transfer proceeded successfully. The patient had an uncomplicated post-operative course until developing a local recurrence at three months post-resection. We believe that the perfusion technology already created for solid organ transplant will have expanding indications in the future of free tissue transfer and limb replantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using a kidney pump to perfuse a free filet flap for reconstruction after hemipelvectomy: A case report

et al. 2018

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“…151 This group subsequently demonstrated that utilization of hourly neuromuscular electrical stimulation could prolong VCA survival up to 24 h. 152 Slater et al demonstrated that ex vivo oxygenated perfusion of free flaps (i.e., porcine myocutaneous rectus abdominis flaps) during ischemia time abrogated tissue damage (due to cell necrosis) over a 24-h period compared to control groups where tissues were flushed with heparinized autologous blood followed by cold storage. 153 This approach has also been successfully applied to muscle Figure reproduced with permission from Elsevier. 134 Color images are available online.…”

Section: Extracorporeal Perfusion Systems and Cross-circulationmentioning

confidence: 99%

Applied Bioengineering in Tissue Reconstruction, Replacement, and Regeneration

Colazo

Evans

Farinas

et al. 2019

Tissue Engineering Part B: Reviews

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To this day, tissue reconstruction and replacement to address extensive tissue defects due to trauma, tumor resection, genetic and/or chronic diseases, or excessive debridement present a major clinical challenge. Traditional reconstructive techniques most commonly utilize autologous tissue. Undoubtedly, autologous composite tissue transfers or ''flaps,'' skin grafts, as well as the harvesting of bone and/or cartilage have substantially improved the health, functional, and aesthetic outcomes of millions of patients. Unfortunately, these procedures are not without their drawbacks. These include increased operative time, complexity, cost, limited availability of qualitative autologous tissue, wound healing complications, tissue flap failure, and substantial donor-site morbidity. Recently, collaborative research teams-consisting of surgeons, scientists, and engineers-have made substantial progress in their attempts to solve these problems. This article provides historical perspective, covers the major limitations of current standards of care, and reviews recent advances and future prospects in applied bioengineering in the context of tissue reconstruction, replacement, and regeneration.

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“…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.…”

Section: Perfusatementioning

confidence: 99%