J Reconstr Microsurg 2019; 35(02): 097-107
DOI: 10.1055/s-0038-1667298
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Hyperbaric Warm Perfusion System Preserves Tissue Composites Ex vivo and Delays the Onset of Acute Rejection

Charles Anton Fries
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
2  Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, United Kingdom
,
Carole Yasay Villamaria
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
3  Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
,
Jerry Richard Spencer
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
4  59 MDW/Science and Technology, Joint Base San Antonio, Texas
,
Shari Lawson
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
,
Lin Wang
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
,
Thomas Raj
5  Department of Pathology, Brooke Army Medical Center, San Antonio, Texas, United States
,
E. George Wolf
6  Hyperbaric Oxygen Organ Preservation Systems, San Antonio, Texas
,
Bijaya Kumar Parida
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
4  59 MDW/Science and Technology, Joint Base San Antonio, Texas
,
Vijay Saradhi Gorantla
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
,
Rory Frederick Rickard
2  Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham, United Kingdom
,
Michael Robert Davis
1  Department of Reconstructive Surgery, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
4  59 MDW/Science and Technology, Joint Base San Antonio, Texas
› Author Affiliations
Funding This work was funded by the 59 MDW Office of Science and Technology of the U.S. Air Force and by the UK Ministry of Defense.
Further Information

Publication History

01 March 2018

18 June 2018

Publication Date:
12 August 2018 (online)

Abstract

Background Ischemia–reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA.

Methods A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts (n = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours. Intervention autografts (n = 5) were placed in a hyperbaric oxygen organ preservation system for 5 hours and infused with hyperoxygenated UWS at 20°C and 3 atm. Grafts were replanted into the animals' necks. In phase 2, similarly treated control (n = 8) and intervention grafts (n = 8) were allotransplanted into the necks of animals separated by a typed and standardized genetic mismatch. No systemic immunosuppression was given. Systemic markers of IRI, and clinical and histopathological assessments of necrosis and rejection were performed.

Results Autotransplanted tissue composites preserved in the hyperbaric chamber showed histopathological evidence of less muscle necrosis at 3 hours (p = 0.05). Despite a longer period of ischemia, no evidence was found of a difference in systemic markers of IRI following revascularization in these groups. Allotransplanted tissues supported ex vivo within the hyperbaric perfusion device experienced acute rejection significantly later than corresponding controls.

Conclusion Hyperbaric warm perfusion preserves musculocutaneous tissue composites ex vivo for longer than standard cold preservation in this model. This translates into a delay in acute rejection of allotransplanted tissue composites.

Disclosure

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of Departments of the Air Force, the Army, the U.S. Department of Defense, or the UK Ministry of Defense.


This study was conducted under a protocol reviewed and approved by the Air Force Medical Service (AFMS), Wilford Hall Ambulatory Surgical Center (WHASC), Institutional Animal Care and Use Committee (IACUC), and the IACUC of the Tri-Service Research Laboratory, Fort Sam Houston, San Antonio, TX.


This study was conducted in the performance of Cooperative Research and Development Agreement number 10-333-WHMC-CRADA2 between Wilford Hall Ambulatory Surgical Center and Hyperbaric Oxygen Organ Preservation Systems.