• Lei Zhang, Ramin Ipaktchi, Bilal Ben Brahim, Isabel Arenas Hoyos, Hansjörg Jenni, Lena Dietrich, Alain Despont, Jane Shaw-Boden, Svenja Büttiker, David Siegrist, Mitra Gultom, Chiara Parodi, Luisana Garcia Casalta, Mariafrancesca Petrucci, Ilaria Petruccione, Alessandro Mirra, Kay Nettelbeck, Junhua Wang, Simone de Brot, Esther Voegelin, Daniela Casoni, and Robert Rieben.
• Department for BioMedical Research, DBMR, University of Bern, Bern 3008, Switzerland.
• Mil Med. 2024 Aug 19; 189 (Supplement_3): 839283-92.

IntroductionContinuous extracorporeal perfusion (ECP), or machine perfusion, holds promise for prolonged skeletal muscle preservation in limb ischemia-reperfusion injury. This study aimed to extend the amputation-to-replantation time window from currently 6 hours to 33 hours using a 24-hour ECP approach.Materials And MethodsSix large white pigs underwent surgical forelimb amputation under general anesthesia. After amputation, limbs were kept for 9 hours at room temperature and then perfused by 24-hour ECP with a modified histidine-tryptophan-ketoglutarate (HTK) solution. After ECP, limbs were orthotopically replanted and perfused in vivo for 12 hours. Clinical data, blood, and tissue samples were collected and analyzed.ResultsAll 6 forelimbs could be successfully replanted and in vivo reperfused for 12 hours after 9 hours of room temperature ischemia followed by 24 hours ECP. Adequate limb perfusion was observed after replantation as shown by thermography and laser Doppler imaging. All pigs survived without severe organ failure, and no significant increase in inflammatory cytokines was found. Macroscopy and histology showed marked interstitial muscular edema of the limbs, whereas myofiber necrosis was not evident, implying the preservation of muscular integrity.ConclusionsThe use of a 24-hour ECP has successfully extended limb preservation to 33 hours. The modified histidine-tryptophan-ketoglutarate perfusate demonstrated its ability for muscle protection. This innovative approach not only facilitates limb replantation after combat injuries, surmounting geographical barriers, but also broadens the prospects for well-matched limb allotransplants across countries and continents.© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.

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