1. Ischemia/reperfusion injury of porcine limbs after extracorporeal perfusion
- Author
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F. Vollbach, Anjan K. Bongoni, David Kiermeir, Thusitha Gajanayake, Martino Meoli, Andrej Banic, Jan A. Plock, Sabine Müller, Hansjörg Jenni, Robert Rieben, Esther Vögelin, Mihai A. Constantinescu, University of Zurich, and Rieben, Robert
- Subjects
Male ,Extracorporeal Circulation ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,Ischemia ,610 Medicine & health ,030230 surgery ,Revascularization ,03 medical and health sciences ,0302 clinical medicine ,Von Willebrand factor ,Internal medicine ,medicine ,Animals ,10266 Clinic for Reconstructive Surgery ,Complement Activation ,biology ,business.industry ,Extracorporeal circulation ,Endothelial Cells ,Extremities ,Heparin ,medicine.disease ,2746 Surgery ,10022 Division of Surgical Research ,Reperfusion Injury ,030220 oncology & carcinogenesis ,Anesthesia ,Replantation ,Cardiology ,biology.protein ,Cytokines ,Intercellular Signaling Peptides and Proteins ,Female ,Surgery ,business ,Reperfusion injury ,Perfusion ,medicine.drug - Abstract
Background Revascularization of amputated extremities after prolonged ischemia is complicated by reperfusion injury. We assessed ischemia/reperfusion (I/R) injury of porcine extremities after prolonged preservation using extracorporeal circulation (ECC). Methods Forelimbs of 32 pigs were divided into four groups based on ischemia times: group I: 6 h, group II: 12 h, group III: 0 h plus replantation, and group IV: 6 h plus replantation. Limbs were perfused with autologous blood using ECC for 12 h except group II with only 5 h perfusion. Limbs from groups III and IV were heterotopically replanted with a 7-d follow-up. Contralateral limbs served as controls in all groups. Tissue, plasma, and serum were analyzed for the extent of I/R injury. Results No significant differences in tissue wet/dry ratios were found within or between groups. This finding was confirmed by histology, except for an increased damage in group IV muscles compared with baseline (P = 0.016). Complement C3 deposition was only increased in group IV muscle (P = 0.031), group II nerves (P = 0.046), and group II vessels (P = 0.037). Group IV muscle and nerve tissues were the only ones with significant IgM antibody deposition (P = 0.031) at end of perfusion. Values were normal again after replantation. Reduced complement activity and elevated IL-6, IL-8, MCP-1, VEGF, PDGF-bb, bFGF, and complement split products were found during perfusion but were normal again after replantation. Staining for heparin sulfate proteoglycans and von Willebrand factor confirmed minimal activation of endothelial cells. Conclusion The results demonstrate that prolonged limb preservation using ECC has minimal impact on I/R-induced tissue injury. Extracorporeal perfusion is a potential limb-preserving technique encouraging further studies for use in limb revascularization.
- Published
- 2013