Extracorporeal perfusion – reduced to a one-way infusion

Article type: Research Article

Authors: Taeger, Christian D.^{a; *} | Friedrich, Oliver^b | Horch, Raymund E.^c | Drechsler, Caroline^c | Weigand, Annika^c | Hopf, Fabio^d | Geppert, Carol I.^e | Münch, Frank^f | Birkholz, Torsten^g | Wenzel, Carina^a | Geis, Sebastian^a | Prantl, Lukas^a | Buchholz, Rainer^d | Präbst, Konstantin^d

Affiliations: [a] Department of Plastic and Hand Surgery, University Hospital of Regensburg, Regensburg, Germany | [b] Institute of Medical Biotechnology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany | [c] Department of Plastic and Hand Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany | [d] Institute of Bioprocess Engineering, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany | [e] Pathology and Anatomy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany | [f] Department of Paediatric Cardiac Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany | [g] Department of Anaesthesiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany

Correspondence: [*] Corresponding author: Christian D. Taeger, M.D., Department of Plastic and Hand Surgery, University Hospital of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Tel.: +49 0941 9446763; E-mail: christian.taeger@ukr.de.

Abstract: BACKGROUND:Extracorporeal perfusion (EP) is moving into focus of research in reconstructive and transplantation medicine for the preservation of amputates and free tissue transplants. The idea behind EP is the reduction of ischemia-related cell damage between separation from blood circulation and reanastomosis of the transplant. Most experimental approaches are based on a complex system that moves the perfusate in a circular course. OBJECTIVE AND METHODS:In this study, we aimed to evaluate if a simple perfusion by an infusion bag filled with an electrolyte solution can provide acceptable results in terms of flow stability, oxygen supply and viability conservation for EP of a muscle transplant. The results are compared to muscles perfused with a pump system as well as muscles stored under ischemic conditions after a one-time intravasal flushing with Jonosteril. RESULTS:With this simple method a sufficient oxygen supply could be achieved and functionality could be maintained between 3.35 times and 4.60 times longer compared to the control group. Annexin V positive nuclei, indicating apoptosis, increased by 9.7% in the perfused group compared to 24.4% in the control group. CONCLUSIONS:Overall, by decreasing the complexity of the system, EP by one-way infusion can become more feasible in clinical situations.

Keywords: Extracorporeal perfusion, external field stimulation, free flap perfusion, reperfusion, ischemia, free flap transplantation

DOI: 10.3233/CH-170298

Journal: Clinical Hemorheology and Microcirculation, vol. 79, no. 2, pp. 257-267, 2021