Current insights into extracorporeal perfusion of free tissue flaps and extremities: a systematic review and data synthesis

Kruit, A. S. and Winters, H. and van Luijk, J. and Schreinemachers, M. J. M. and Ulrich, D. J. O.

J Surg Res (2018) 227: 7–16

DOI: 10.1016/j.jss.2018.01.023

Abstract

BACKGROUND: Extracorporeal perfusion is a promising new technique for prolonged preservation of free flaps and extremities; however, uncertainties on perfusion settings and efficacy still exist. No overview of literature is currently available. This review systematically appraised available evidence comparing extracorporeal perfusion to static storage. MATERIALS AND METHODS: An electronic systematic search was performed on June 12, 2016, in MEDLINE and EMBASE. Articles were included when evaluating the effect of extracorporeal perfusion of free flaps or extremities compared to that of a control group. Two independent researchers conducted the selection process, critical appraisal, and data extraction. RESULTS: Of 3485 articles screened, 18 articles were included for further analyzation. One article studied discarded human tissue; others were studies conducted on rats, pigs, or dogs. Perfusion periods varied from 1 h to 10 d; eight articles also described replantation. Risk of bias was generally scored high; none of the articles was excluded based on these scores. Tissue vitality showed overall better results in the perfused groups, more pronounced when perfusing over 6 h. The development of edema was a broadly described side effect of perfusion. CONCLUSIONS: Although tissue vitality outcomes seem to favor extracorporeal perfusion, this is difficult to objectify because of large heterogeneity and poor quality of the available evidence. Future research should focus on validating outcome measures, edema prevention, perfusion settings, and maximum perfusion time for safe replantation and be preferably performed on large animals to increase translation to clinical settings.

Citation

Kruit, A. S., Winters, H., van Luijk, J., Schreinemachers, M. J. M., & Ulrich, D. J. O. (2018). Current insights into extracorporeal perfusion of free tissue flaps and extremities: a systematic review and data synthesis. J Surg Res, 227, 7–16. https://doi.org/10.1016/j.jss.2018.01.023 Animals, Rats, Humans, Dogs, Swine, Time Factors, Treatment Outcome, Models, Animal, *Graft Survival, *Ex vivo perfusion, *Extracorporeal perfusion, *Free flap surgery, *Free Tissue Flaps, *Preservation, *Vascularized composite allotransplantation, Edema/*etiology, Extremities, Perfusion/adverse effects/*methods, Replantation/adverse effects/*methods

Keywords

• Animals
• Rats
• Humans
• Dogs
• Swine
• Time Factors
• Treatment Outcome
• Models
• Animal
• *Graft Survival
• *Ex vivo perfusion
• *Extracorporeal perfusion
• *Free flap surgery
• *Free Tissue Flaps
• *Preservation
• *Vascularized composite allotransplantation
• Edema/*etiology
• Extremities
• Perfusion/adverse effects/*methods
• Replantation/adverse effects/*methods