Speaker
Description
Background
Access to healthy living tissue in the lab has always been an essential substrate for experimentation across the breadth of medical research. Historically limited to live animal studies using small mammals such as rats, and subsequently more anatomically and physiologically analogous animals such as pigs, recent developments in cellular technologies have allowed for the in-vitro production of human tissue, such as the development of spheroid and organoid technologies, which allow for the study of 3D cell structures in a microenvironment that mimics the in-vivo environment. However, they remain unable to completely recreate in-vivo conditions, including issues of scale and maintaining macroscopic tissue architecture.
This project aims to validate a reliable lab-based human model for normothermic perfusion of tissue using human blood products. This would provide a higher fidelity tissue for research applications and incredible scope for use in tissue engineering and biofabrication as a vascularised living substrate for the development of engineered tissue in a simulated in-vivo environment.
Method
We present a case series of 5 consecutive patients undergoing unilateral autologous breast reconstruction using DIEP flap or cosmetic abdominoplasty, with the redundant abdominal flap placed on ex-vivo ECMO perfusion until tissue demise. Tissue viability was assessed using clinical, biochemical and histopathological parameters, alongside demographic and technical factors that influenced flap longevity.
Results
Mean survival time was 3.8 days (max 8 days), with mechanical venous congestion the primary cause of demise in 80% of cases, and progressive venous congestion in 20%.
Conclusion
The preliminary results in this study demonstrate that extracorporeal normothermic perfusion of human free tissue flaps is feasible, with current results in line or exceeding the currently reported survival data in the literature across all forms of ex-vivo tissue perfusion. Ongoing technical improvements of the experimental setup will undoubtedly improve these outcomes further.
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