DEVELOPMENT OF PERFUSATE FOR COMPOSITE TISSUE ALLOGRAFT - NEW MANEUVERS FOR ISCHEMIC GOLDEN PERIOD

Jun Araki¹, Makoto Mihara¹, Mitsunaga Narushima¹, Isao Koshima¹, Yoshihiro Mano², Hiromi Sakai³.

¹Department of Plastic Surgery, University of Tokyo, Tokyo, Japan; ²Tokyo Medical and Dental University Hospital, Tokyo, Japan; ³Waseda Bioscience Research Institute in Singapore, Helios, Singapore.

Objective: In the management of traumatic limb amputation, it is important to consider ischemic time and reperfusion injury by free radicals when blood supply is reestablished. These considerations must be weighed even more seriously in macroreplantation cases. To have the greatest chance for success, replantation operations require a minimizing unnecessary ischemic injury. This abstract reports a successful case of hand replantation after long ischemia time and the development of perfusate for Composite Tissue Allograft.

Design and method: A 55-year-old man suffered complete amputation of his left hand 0.5 inches distal from the wrist. He arrived at our hospital 4 hours and 20 minutes after his accident. We performed three simple maneuvers before hand replantation to shorten the warm ischemia time and minimize muscle necrosis.

1. Blood was aspirated from the femoral artery and infused through the radial artery.

2. The dorsalis pedis artery and vein were then anastomosed to the radial artery and vein.

3. One hour prior to replantation, University of Wisconsin solution was used to flush the hand vasculature.

The aim of these maneuvers was maintain blood pH and electrolyte stability. Microsurgical replantation started 10 hours after injury. Reperfusion was achieved approximately 12 hours after injury.

Results: The amputated hand survived completely. There was no evidence of reperfusion injury.

Conclusions: We achieved a successful microsurgical complete hand replantation despite 12 hours of ischemic time. This illustrates that it is possible to extend the ischemic golden period. After this experience, we develop “Dynamic Preservation Method” which focuses the oxygen supply. This is a special combination of ET-kyoto solution (existing　organ storage solution), artificial hemoglobin and oxygen nano-bubble. This persusate may overcome an ischemic time limit which is the one of the problems of the allotransplantation.