Improved preservation of skeletal muscle in amputated limbs using pulsatile hypothermic perfusion with University of Wisconsin solution. A preliminary study.
To determine whether pulsatile hypothermic perfusion with University of Wisconsin preservation solution is superior to topical cooling as a method for the preservation of amputated limbs, six pairs of amputated canine limbs were preserved for twelve to fifteen hours. One limb of each pair was subjected to topical cooling and the other, to pulsatile hypothermic perfusion with University of Wisconsin solution. The bioenergetic status of the limbs was monitored by 31phosphorus magnetic-resonance spectroscopy, and histological evaluation was performed to assess ischemic changes in the preserved tissue. The pH and tissue levels of adenosine triphosphate declined three times more slowly in the limbs that were preserved by pulsatile hypothermic perfusion than in the topically cooled limbs. Consistent with these findings, the perfused limbs also had less histological evidence of ischemic injury. The data from this in vitro study show that pulsatile hypothermic perfusion with University of Wisconsin solution, in combination with an optimum degree of topical cooling, is superior to topical cooling alone as a method of preserving the bioenergetic status of amputated limbs.
Gordon
L
L
Veterans Administration Hospital, San Francisco, California.
Levinsohn
D G
DG
Borowsky
C D
CD
Manojlovic
R D
RD
Sessler
D I
DI
Weiner
M W
MW
Baker
A J
AJ
D000241:Adenosine; D000255:Adenosine Triphosphate / Q000378:metabolism; D000493:Allopurinol; D000671:Amputation, Surgical; D000818:Animals; D003080:Cold Temperature; D004285:Dogs; D005978:Glutathione; D006614:Hindlimb / Q000293:injuries / Q000601:surgery*; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D007328:Insulin; D009682:Magnetic Resonance Spectroscopy; D009132:Muscles / Q000378:metabolism* / Q000473:pathology; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods; D011673:Pulsatile Flow; D011887:Raffinose; D012092:Replantation; D012996:Solutions; D014021:Tissue Preservation / Q000379:methods*
D007328:Insulin; D019188:Organ Preservation Solutions; D012996:Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose