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Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model
Cold storage remains the clinical standard for composite tissue preservation but is time-limited. A long ischemia time during surgery will adversely affect postoperative outcomes due to ischemia-reperfusion injury. Extracorporeal perfusion (ECP) seems to be a promising alternative for prolonged pres...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432231/ https://www.ncbi.nlm.nih.gov/pubmed/34501304 http://dx.doi.org/10.3390/jcm10173858 |
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author | Kruit, Anne Sophie van Midden, Dominique Schreinemachers, Marie-Claire Koers, Erik Zegers, Her Kusters, Benno Hummelink, Stefan Ulrich, Dietmar J. O. |
author_facet | Kruit, Anne Sophie van Midden, Dominique Schreinemachers, Marie-Claire Koers, Erik Zegers, Her Kusters, Benno Hummelink, Stefan Ulrich, Dietmar J. O. |
author_sort | Kruit, Anne Sophie |
collection | PubMed |
description | Cold storage remains the clinical standard for composite tissue preservation but is time-limited. A long ischemia time during surgery will adversely affect postoperative outcomes due to ischemia-reperfusion injury. Extracorporeal perfusion (ECP) seems to be a promising alternative for prolonged preservation, but more evidence is needed to support its use and to identify optimal perfusion fluids. This article assessed musculocutaneous flap vitality after prolonged ECP and compared outcomes after replantation to short static cold storage (SCS). Unilateral musculocutaneous rectus abdominis flaps were raised from 15 pigs and preserved by 4 h SCS (n = 5), 18 h mid-thermic ECP with Histidine–Tryptophan–Ketoglutarate (HTK, n = 5) or University of Wisconsin solution (UW, n = 5). Flaps were replanted and observed for 12 h. Skeletal muscle histology was assessed (score 0–12; high scores equal more damage), blood and perfusate samples were collected and weight was recorded as a marker for oedema. Mean histological scores were 4.0 after HTK preservation, 5.6 after UW perfusion and 5.0 after SCS (p = 0.366). Creatinine kinase (CK) was higher after ECP compared to SCS (p < 0.001). No weight increase was observed during UW perfusion, but increased 56% during HTK perfusion. Following 12 h reperfusion, mean weight gain reduced 39% in the HTK group and increased 24% in the UW group and 17% in the SCS group. To conclude, skeletal muscle seemed well preserved after 18 h ECP with HTK or UW perfusion, with comparable histological results to 4 h SCS upon short reperfusion. The high oedema rate during HTK perfusion remains a challenge that needs to be further addressed. |
format | Online Article Text |
id | pubmed-8432231 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-84322312021-09-11 Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model Kruit, Anne Sophie van Midden, Dominique Schreinemachers, Marie-Claire Koers, Erik Zegers, Her Kusters, Benno Hummelink, Stefan Ulrich, Dietmar J. O. J Clin Med Article Cold storage remains the clinical standard for composite tissue preservation but is time-limited. A long ischemia time during surgery will adversely affect postoperative outcomes due to ischemia-reperfusion injury. Extracorporeal perfusion (ECP) seems to be a promising alternative for prolonged preservation, but more evidence is needed to support its use and to identify optimal perfusion fluids. This article assessed musculocutaneous flap vitality after prolonged ECP and compared outcomes after replantation to short static cold storage (SCS). Unilateral musculocutaneous rectus abdominis flaps were raised from 15 pigs and preserved by 4 h SCS (n = 5), 18 h mid-thermic ECP with Histidine–Tryptophan–Ketoglutarate (HTK, n = 5) or University of Wisconsin solution (UW, n = 5). Flaps were replanted and observed for 12 h. Skeletal muscle histology was assessed (score 0–12; high scores equal more damage), blood and perfusate samples were collected and weight was recorded as a marker for oedema. Mean histological scores were 4.0 after HTK preservation, 5.6 after UW perfusion and 5.0 after SCS (p = 0.366). Creatinine kinase (CK) was higher after ECP compared to SCS (p < 0.001). No weight increase was observed during UW perfusion, but increased 56% during HTK perfusion. Following 12 h reperfusion, mean weight gain reduced 39% in the HTK group and increased 24% in the UW group and 17% in the SCS group. To conclude, skeletal muscle seemed well preserved after 18 h ECP with HTK or UW perfusion, with comparable histological results to 4 h SCS upon short reperfusion. The high oedema rate during HTK perfusion remains a challenge that needs to be further addressed. MDPI 2021-08-27 /pmc/articles/PMC8432231/ /pubmed/34501304 http://dx.doi.org/10.3390/jcm10173858 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kruit, Anne Sophie van Midden, Dominique Schreinemachers, Marie-Claire Koers, Erik Zegers, Her Kusters, Benno Hummelink, Stefan Ulrich, Dietmar J. O. Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title | Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title_full | Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title_fullStr | Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title_full_unstemmed | Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title_short | Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model |
title_sort | rectus abdominis flap replantation after 18 h hypothermic extracorporeal perfusion—a porcine model |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432231/ https://www.ncbi.nlm.nih.gov/pubmed/34501304 http://dx.doi.org/10.3390/jcm10173858 |
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