Abstract
INTRODUCTION: At the moment there is no reliable method to minimize tissue damage occurring during the ischemia time in free flap reconstructive surgery. In the current pilot study the feasibility of a novel extracorporal preservation method was explored aimed at minimizing tissue damage during ischemia time in free flap transfer. Initial results are presented. MATERIALS AND METHODS: A modified heart-lung machine was assembled to allow semi-closed extra-corporal oxygenated perfusion of free flaps. Porcine rectus abdominis flaps pedicled on the superior epigastric artery were harvested. Different test groups were created aimed at testing various preservation methods of flaps: I continuous perfusion with normothermic oxygenated heparinized autologous blood; II continuous perfusion with cooled (7 degrees Celcius) and oxygenated histidine-tryptophan-ketoglutarate (HTK) or University of Wisconsin (UW) solution; III short flush (eight minutes) with HTK, UW or saline and heparin solution after which cooled (4 degrees Celsius) preservation. Muscle biopsies were taken for histological analysis at various timepoints during the 24 hour experiments. RESULTS: Flaps from groups I and II were successfully attached to the modified heart-lung machine while maintaining stable flow and pressure. After three hours flaps from groups I and III already showed signs of cell death (contraction band necrosis) increasing throughout the experiment. Flaps from group II showed minimal (UW) or no such signs (HTK) throughout the 24-hour experiments. CONCLUSIONS: The use of a modified heart-lung machine to allow oxygenated perfusion of free flaps provides new possibilities to minimize tissue damage during ischemia time and further study of its use is warranted. 11.10–12.10 SESSION 8 – OUTCOME / CLINICAL (PART 2) Moderators Philip BLONDEEL Rene LARGO
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