Preservation of rat limbs by hyperbaric carbon monoxide and oxygen

Cold ischemia times ranging from <6 h to as long as 24 h are generally quoted as the limits for attempting the replantation of amputated extremities. In this study, we aimed to assess the effect of hyperbaric carbon monoxide (CO) and oxygen (O(2)) on rat limb preservation. Donor rat limbs were preserved in a chamber filled with hyperbaric CO and O(2) for 3 days (CO + O(2) 3 days) or 7 days (CO + O(2) 7 days). Positive and negative control groups were created by using non-preserved limbs (NP) and limbs wrapped in saline-moistened gauze for 3 days (SMG 3 days), respectively. The survival rate of transplanted limbs at postoperative day 90 was 88% in the NP and 86% in the CO + O(2) 3 days. The corresponding survival rate was 50% in the CO + O(2) 7 days at postoperative day 90 but was 0% in the SMG 3 days at postoperative day 3. Muscle mass decreased in the CO + O(2) 3 days and CO + O(2) 7 days compared with the NP, but sciatic–tibial nerve conduction velocities did not differ. These results indicate that amputated extremities preservation with hyperbaric CO and O(2) could extend the time limits of preservation, maintaining their viability for replantation.