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Can Prolonged Ischemia Time in Extremity Transfer Be Resolved Using an Extracorporeal Circulation Model? An

Suleyman Yildizdal¹, Özbeyen Atalay², Deniz Önal³

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey.

Annals of Plastic Surgery

|March 17, 2026

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This summary is machine-generated.

Extracorporeal perfusion (ECP) demonstrates reduced oxidative and inflammatory damage compared to cold ischemic transport (CIT) for limb preservation. This suggests ECP may offer superior protection against ischemia-reperfusion injury in clinical extremity transport.

Area of Science:

Biomedical Engineering
Regenerative Medicine
Surgical Innovation

Background:

Standard cold ischemic transport (CIT) for limb preservation is limited by incomplete prevention of ischemia-reperfusion injury (IRI).
Extracorporeal perfusion (ECP) offers a potential alternative by maintaining a metabolic environment for ischemic tissues.
Investigating ECP's efficacy against IRI compared to CIT is crucial for advancing transplantation and replantation techniques.

Purpose of the Study:

To compare the effectiveness of extracorporeal perfusion (ECP) versus cold ischemic transport (CIT) in mitigating ischemia-reperfusion injury (IRI).
To evaluate the impact of ECP and CIT on oxidative stress, inflammation, apoptosis, and tissue damage in an ischemia-reperfusion model.

Main Methods:

Utilized an ischemia-reperfusion model with a 6-hour ischemia and 1-hour reperfusion period.

Keywords:

cold ischemic transport method extracorporeal circulation model ischemia-reperfusion injury oxidative stress

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Assessed biochemical markers of oxidative damage (superoxide dismutase, catalase, total antioxidant/oxidant status, total thiol) and inflammation (TNF-α, NF-κB, IL-10).

Evaluated apoptosis via Bax and Bcl-2 protein levels and performed histopathologic examination, including mitochondrial assessment via Cox staining.

Main Results:

ECP exhibited significantly less oxidative and inflammatory damage compared to CIT.
Biochemical parameters indicative of damage were elevated in the CIT group.
Histopathologic analysis revealed greater mitochondrial damage in tissues subjected to CIT.

Conclusions:

ECP demonstrates superior outcomes in reducing inflammatory and oxidative damage compared to CIT.
The findings support the potential clinical application of ECP for extremity transport to minimize histopathologic damage.
ECP represents a promising strategy for improving tissue viability and outcomes in limb transplantation and replantation.