A Novel Application of Normothermic Machine Perfusion for Face Recovery to Reduce Intragraft Inflammation and Optimize Organ Viability
Abstract
Warriors who suffer from combat-related injuries. Face transplantation is currently the only treatment option to fully restore devastating craniofacial injuries with functional and anatomical equivalents by replacing "like-with-like" tissue. Recent advances in microsurgical techniques and immunosuppressive protocols have enabled wider application of face transplantation with highly encouraging results. However, the current gold standard in tissue preservation - static cold storage on ice - is insufficient to preserve facial allografts for more than a few hours. Advancements in the field of VCA regarding matching and allocation, desensitization, and potential tolerance induction are all within reasonable reach to achieve; these are, however, constrained by limited preservation time. Thus, this project applies normothermic machine perfusion (NMP), as practiced clinically in vital organ transplant, to the specific and unique requirements of the face to increase tissue viability and to reduce both ischemia reperfusion injury and inflammatory potential. Initial trials showed excellent feasibility of surgical flap harvest as well as vascular cannulation. Grafts tolerated 24 hours of perfusion without any gross signs of tissue ischemia or necrosis. Weight change from experimental start to the end of perfusion ranged from 6 percent to 16 percent in our trial flaps with minimal visible edematous changes. H and E analysis showed normal appearing skin in both the flaps after 24 hours of perfusion. Biochemical analysis showed little chemical change in the monitored analytes to suggest tissue ischemia or cell death.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2020
- Accession Number
- AD1120996
Entities
People
- Gerald Brandacher
- John Brassil
Organizations
- Johns Hopkins University