Forty-Eight Hour Ex Vivo Perfusion and Two-Hour Simulated Reperfusion after a Major Traumatic Upper Extremity Amputation

Abstract Background Extremity replantation as well allotransplantation aim to restore form and function of the amputated limb. Both approaches, however, are clearly limited by ischemic time. Ex vivo perfusion (EVP), already well-established in field solid organ transplantation, represents a promising tool overcome this restriction. Methods We have currently established technical requirements provide EVP severed limbs clinical hospital setting hereby report 48-hour hypothermic (EVP48) an upper extremity at level proximal humerus, followed 2-hour simulated reperfusion (2SR) with donor blood. Results Muscle biopsies revealed histopathologically preserved, vital muscle tissue after EVP24, partially grouped fiber necrosis predominantly EVP48 2SR. Analyses perfusate samples showed marked decline biochemical damage markers during EVP48. Cytokine analysis disclosed isolated increase proinflammatory cytokines, interleukine-6, monocyte chemotactic protein-1, interferon-γ, Magnetic resonance imaging, performed EVP48, indicated partial intrinsic hand muscles only, while no signs for infection or inflammation were present. Conclusion Our single case experience shows general feasibility limb ex salvage allow delayed up 24 hours. Nevertheless, accurate prior planning is crucial ensure successful implementation acute setting.