Limb Preservation in Replantation Surgery

Extracorporeal perfusion of isolated organs of large animals – Bridging the gap between in vitro and in vivo studies

“…To summarize, due to the lack of hepatic clearance a rise in lactate levels can be observed in the majority of perfusion experiments over time, even if measurements do not exceed the physiological range by the end of the experiment (Smith et al, 1985;Riviere et al, 1989;Adham et al, 1997;Polyak et al, 2008). A small decrease of lactate levels may be observed after several hours of perfusion, which may be explained by modest lactate utilization by myocytes (Constantinescu et al, 2011).…”

“…This approach was most likely used in various experiments in which the publications solely mention the use of "gassed" (Kietzmann et al, 1993) or "oxygenated" (Bäumer and Kietzmann, 1999) perfusates without further specification of the oxygenation system. Perfusate reservoirs may be gassed using glassware with a sintered glass filter (Tindal, 1957), with a bubble oxygenator, which bubbles (pure) oxygen through the blood reservoir (Smith et al, 1985), or by using a rotating disc oxygenator Cameron et al, 1972), whereby several parallel discs rotate within the reservoir containing unoxygenated blood and the gas exchange occurs at the disc-blood interface. More recently, the use of membrane or hollow fiber oxygenators (Butler et al, 2002;Müller et al, 2013) typically deployed during CPB surgery or life support (extracorporeal membrane oxygenation) has been reported in perfusion experiments.…”

“…Hypothermic perfusions are adopted for isolated organ and limb perfusions with the aim to promote organ preservation and facilitate reimplantation (Smith et al, 1985;Domingo-Pech et al, 1991;Guarrera et al, 2004;Constantinescu et al, 2011;Müller et al, 2013). Hypothermia slows cellular metabolism and oxygen consumption, allowing lower flow rates and perfusates without specific oxygen carriers to meet metabolic requirements (Fuller and Lee, 2007).…”

“…The arterial oxygen content represents the volume of oxygen carried per 100 ml blood and is calculated by: fluorocarbons were tested with equivocal results (Usui et al, 1985;Smith et al, 1985).…”

“…Increases in lactate concentration have also been observed after arterial reservoir exchanges resulted in a period of relatively low O 2 saturation of the perfusate due to the new reservoir solution not yet being fully oxygenated (Patan et al, 2009). Friebe et al (1993) postulate in their minimum requirements for viability of the equine distal limb a lactate production of ≤ 400 mg/h, a criterion met by their and other Despite these initial positive results, fluorocarbon containing solutions had only moderate success during clinical trials of human digital replantation following perfusion (Smith et al, 1985). Fluorocarbon is also known to reduce neutrophil infiltration, which might be an interesting characteristic in organ preservation but could affect outcomes in research applications of the perfusion model (Forman et al, 1992).…”