Can prolonged ischemia time in extremity transfer be resolved using an extracorporeal circulation model? An experimental study

Abstract

Background: The standard method for transporting tissues during limb transplantation and replantation is cold ischemic transport (CIT). However, CIT cannot completely prevent ischemia-reperfusion injury (IRI). As an alternative, extracorporeal perfusion (ECP) methods that provide an adequate metabolic environment for ischemic tissues could be considered. In this study, we investigated the differences between CIT and ECP in terms of their effects on IRI. c e and Key Words: ischemia-reperfusion injury, oxidative stress, extracorporeal circulation model, cold ischemic transport method (Ann Plast Surg 2026;96:455–462) Methods: An ischemia-reperfusion model was used to compare the CIT and ECP groups. This model includes a 6-hour ischemia period followed by a one-hour reperfusion period. Superoxide dismutase, catalase, total antioxidant status, total oxidant status, and total thiol levels in muscle and blood samples were biochemically analyzed to determine oxidative damage levels. TNF-α, NF-κB, and IL-10 levels were measured in the same samples to evaluate the degree of inflammation. Apoptosis was evaluated by measuring the levels of Bax and Bcl-2 proteins in muscle samples. Histopathologic examination was performed for tissue damage and mitochondria were evaluated by Cox staining. Results: It was found that the ECP causes less oxidative and inflam matory damage than the CIT. Bax and bcl-2 levels did not differ between the 2 groups. Biochemical parameters were found to be higher in the CIT group. More mitochondrial damage was observed in the CIT system. Conclusions: ECP caused less inflammatory and oxidative damage compared with CIT. The promising results of our experimental study suggest that the clinical use of extracorporeal circulation machines for extremity transport may reduce histopathologic damage.