<italic style="font-style: italic">Ex vivo</italic> limb perfusion for traumatic amputation in military medicine

Alexander Kaltenborn; Nicco Krezdorn; Sebastian Hoffmann; André Gutcke; Kirsten Haastert-Talini; Peter M. Vogt; Axel Haverich; Bettina Wiegmann

doi:10.1186/s40779-020-00250-y

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Ex vivo limb perfusion for traumatic amputation in military medicine

HYPOTHESIS | Updated：2023-06-05

- Ex vivo limb perfusion for traumatic amputation in military medicine
- Ex vivo limb perfusion for traumatic amputation in military medicine
- MMR 2020年7卷第4期页码：489-496
- Affiliations：
  
  1.Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany.
  2.Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
  3.Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover and Center for Systems Neuroscience (ZSN), Westerstede, Germany.
  4.Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
- Author bio：
  
  * kaltenborn.alexander@mh-hannover.de
- Funds：
- DOI：10.1186/s40779-020-00250-y
  中图分类号：
- 纸质出版：2020-12
- Accepted：
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Ex vivo limb perfusion for traumatic amputation in military medicine[J]. MMR, 2020,7(4):489-496.

Kaltenborn et al.: Ex vivo limb perfusion for traumatic amputation in military medicine. Mil Med Res, 2020, 7: 21.
Ex vivo limb perfusion for traumatic amputation in military medicine[J]. MMR, 2020,7(4):489-496. DOI： 10.1186/s40779-020-00250-y.

Kaltenborn et al.: Ex vivo limb perfusion for traumatic amputation in military medicine. Mil Med Res, 2020, 7: 21. DOI： 10.1186/s40779-020-00250-y.

摘要

Abstract

Background:

Limb loss has a drastic impact on a patient's life. Severe trauma to the extremities is common in current military conflicts. Among other aspects

"life before limb" damage control surgery hinders immediate replantation within the short post-traumatic timeframe

which is limited in part by the ischemic time for successful replantation.

Ex vivo

limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.

Presentation of the hypothesis:

The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable

ex vivo

limb perfusion device

as there are several opportunities present with the introduction of this technique on the horizon. We hypothesize that

ex vivo

limb perfusion will enable overcoming the critical ischemic time

provide surgical opportunities such as preparation of the stump and limb

allow for spare-part surgery

enable rigorous antibiotic treatment of the limb

reduce ischemia-reperfusion injuries

enable a tissue function assessment before replantation

and enable the development of large limb transplant programs.

Testing the hypothesis:

Data from

in vivo

studies in porcine models are limited by the relatively short perfusion time of 24 h. In the military setting

notably longer perfusion times need to be realized. Therefore

future animal studies must focus especially on long-term perfusion

since this represents the military setting

considering the time for stabilization of the patient until evacuation to a tertiary treatment center.

Implications of the hypothesis:

The development and clinical introduction of

ex vivo

limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members.

Ex vivo

limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent

life-threatening situation to a highly methodical

well-prepared starting point for optimal treatment of the wounded service member. With its introduction

the principle of "life before limb" will change to "life before limb before elective replantation/allotransplantation after

ex vivo

limb perfusion".

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references

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Ex vivo limb perfusion for traumatic amputation in military medicine

Ex vivo limb perfusion for traumatic amputation in military medicine

DOI：10.1186/s40779-020-00250-y

摘要

Abstract

关键词

Keywords

references