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...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-08-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/17/3858 |
| _version_ | 1797521259955748864 |
|---|---|
| author | Anne Sophie Kruit Dominique van Midden Marie-Claire Schreinemachers Erik Koers Her Zegers Benno Kusters Stefan Hummelink Dietmar J. O. Ulrich |
| author_facet | Anne Sophie Kruit Dominique van Midden Marie-Claire Schreinemachers Erik Koers Her Zegers Benno Kusters Stefan Hummelink Dietmar J. O. Ulrich |
| author_sort | Anne Sophie Kruit |
| collection | DOAJ |
| 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 (<i>n</i> = 5), 18 h mid-thermic ECP with Histidine–Tryptophan–Ketoglutarate (HTK, <i>n</i> = 5) or University of Wisconsin solution (UW, <i>n</i> = 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 (<i>p</i> = 0.366). Creatinine kinase (CK) was higher after ECP compared to SCS (<i>p</i> < 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. |
| first_indexed | 2024-03-10T08:10:03Z |
| format | Article |
| id | doaj.art-b9b4fdd03abc43668ffda71b438b686d |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T08:10:03Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b9b4fdd03abc43668ffda71b438b686d2023-11-22T10:48:26ZengMDPI AGJournal of Clinical Medicine2077-03832021-08-011017385810.3390/jcm10173858Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine ModelAnne Sophie Kruit0Dominique van Midden1Marie-Claire Schreinemachers2Erik Koers3Her Zegers4Benno Kusters5Stefan Hummelink6Dietmar J. O. Ulrich7Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Plastic and Reconstructive Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsCold 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 (<i>n</i> = 5), 18 h mid-thermic ECP with Histidine–Tryptophan–Ketoglutarate (HTK, <i>n</i> = 5) or University of Wisconsin solution (UW, <i>n</i> = 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 (<i>p</i> = 0.366). Creatinine kinase (CK) was higher after ECP compared to SCS (<i>p</i> < 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.https://www.mdpi.com/2077-0383/10/17/3858VCAex vivo preservationcomposite tissue transplantationmid-thermic storagefree flap |
| spellingShingle | Anne Sophie Kruit Dominique van Midden Marie-Claire Schreinemachers Erik Koers Her Zegers Benno Kusters Stefan Hummelink Dietmar J. O. Ulrich Rectus Abdominis Flap Replantation after 18 h Hypothermic Extracorporeal Perfusion—A Porcine Model Journal of Clinical Medicine VCA ex vivo preservation composite tissue transplantation mid-thermic storage free flap |
| 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 | VCA ex vivo preservation composite tissue transplantation mid-thermic storage free flap |
| url | https://www.mdpi.com/2077-0383/10/17/3858 |
| work_keys_str_mv | AT annesophiekruit rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT dominiquevanmidden rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT marieclaireschreinemachers rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT erikkoers rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT herzegers rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT bennokusters rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT stefanhummelink rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel AT dietmarjoulrich rectusabdominisflapreplantationafter18hhypothermicextracorporealperfusionaporcinemodel |