Towards Portable Leg Perfusion: Initial Prototype Testing of a Selective Leg Perfusion System.

Area of Science:

• Biomedical Engineering
• Trauma Surgery
• Organ Preservation

Background:

• Limb loss is a significant cause of morbidity in combat casualties.
• Tourniquets save lives but can cause prolonged ischemia due to delayed evacuation.
• A dedicated extracorporeal limb perfusion system is being developed for organ preservation.

Purpose of the Study:

• To present preliminary data on the feasibility of a dedicated extracorporeal limb perfusion system.
• To evaluate the efficacy of limb preservation in a simulated combat casualty scenario.

Main Methods:

• Amputated swine hindlimbs were perfused for 6 hours using a system with and without a membrane oxygenator.
• Key parameters including temperature, blood flow, and arterial blood gases were monitored hourly.
• Histological analysis was performed and compared to limbs in cold storage.

Main Results:

• The oxygenated perfusion group (OXY+) demonstrated significantly higher blood pH, base excess, and oxygen saturation compared to the non-oxygenated group (OXY-).
• The OXY+ group also had lower partial pressure of carbon dioxide (pCO2).
• Histological analysis revealed reduced sarcoplasm and sarcolemma damage in the OXY+ group after 6 hours.

Conclusions:

• The developed perfusion system successfully maintained limb circulation without adverse clotting events.
• This purpose-built perfusion system shows promise for limb preservation in large-scale combat operations with delayed evacuation.
• Further development is warranted to optimize limb salvage strategies in military medicine.