LAUSR

‘‘L ife before limb’’ is a simple rule with major consequences. In rare circumstances where a person suffers from a major amputation injury, a decision process for doctors starts immediately as to weighing the limb replantation’s probability of success against the primary goal of patient stabilization. When an immediate replantation is impossible due to the patient’s general condition, damage from prolonged ischemia precludes limb salvage. The susceptibility to ischemic damage depends on the type of tissue, with muscle tissue as the most sensitive tissue toward ischemic damage, limiting the time of warm ischemia to 4 hours. The ischemic processes can be slowed by cooling, but even after storage under cold ischemia for a few hours, the survival rate drops rapidly. Extracorporeal perfusion (EP) has the potential to prolong acceptable storage times with amputated limbs, using techniques adapted from transplant medicine. While animal models have been used at a laboratory scale to show EP feasibility, replantation after EP in a clinical setting has not been reported. Moving toward full clinical application we have shown significant benefits of EP versus standard ischemic cold storage in a porcine muscle flap model, and have used this concept in a first human case where we perfused a free latissimus dorsi flap. We were able to show that it is possible to supply a muscle flap of that size with oxygen using an acellular perfusion solution. Recently, we were faced with 2 cases of amputation injuries within 1 year where rapid replantation after standard cooling was not possible due to the patients’ critical medical condition. To allow successful replantation, we used our EP experience to preserve these amputated limbs.