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A Reliable Porcine Fascio-Cutaneous Flap Model for Vascularized Composite Allografts Bioengineering Studies
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Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study.

Yanis Berkane1,2,3,4,5, Alexandre G Lellouch1,2,4,6, Guillaume Goudot7,8

  • 1Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA.

Bioengineering (Basel, Switzerland)
|December 23, 2023
PubMed
Summary

Machine perfusion of fasciocutaneous flaps shows promise for reconstructive surgery. Intermittent oxygenated perfusion in a porcine model minimized necrosis, suggesting potential for improved flap survival and extended preservation times.

Keywords:
ex vivo perfusionextracorporeal perfusionfasciocutaneous flapsintermittent perfusionmachine perfusionvascularized composite allotransplantation

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Area of Science:

  • Regenerative Medicine
  • Surgical Innovation
  • Vascular Biology

Background:

  • Machine perfusion is advancing reconstructive surgery, particularly for vascularized composite allotransplants.
  • Fasciocutaneous flaps are standard in autologous reconstruction, but vascular complications can lead to failure.
  • Ex vivo perfusion offers a potential solution to overcome microsurgical challenges in free flap transfer.

Purpose of the Study:

  • To evaluate oxygenated acellular sub-normothermic machine perfusion of fasciocutaneous flaps.
  • To compare continuous versus intermittent perfusion regimens.
  • To assess the feasibility of machine perfusion for flap preservation and potential avoidance of microsurgical anastomoses.

Main Methods:

  • Fasciocutaneous flaps in a porcine model underwent 24- and 48-hour oxygenated acellular sub-normothermic perfusion.
  • Continuous and intermittent perfusion strategies were compared.
  • Vascular resistance, edema, arteriovenous oxygen differences, metabolic parameters, and histological assessments were monitored.

Main Results:

  • Successful oxygenated perfusion resulted in minimal to no cell necrosis in porcine flaps.
  • Intermittent perfusion demonstrated superior outcomes at 24 hours compared to continuous perfusion.
  • Intermittent perfusion also allowed for extended perfusion duration.

Conclusions:

  • Oxygenated acellular sub-normothermic machine perfusion is a viable technique for fasciocutaneous flaps.
  • Intermittent perfusion appears more effective than continuous perfusion for short-term preservation.
  • This research supports the development of novel reconstructive techniques utilizing machine perfusion.