The Journal of Bone and Joint Surgery, Vol 74, Issue 9 1358-1366, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Improved preservation of skeletal muscle in amputated limbs using pulsatile hypothermic perfusion with University of Wisconsin solution. A preliminary study
L Gordon, DG Levinsohn, CD Borowsky, RD Manojlovic, DI Sessler, MW Weiner and AJ Baker
Veterans Administration Hospital, San Francisco, California.
To determine whether pulsatile hypothermic perfusion with University of
Wisconsin preservation solution is superior to topical cooling as a method
for the preservation of amputated limbs, six pairs of amputated canine
limbs were preserved for twelve to fifteen hours. One limb of each pair was
subjected to topical cooling and the other, to pulsatile hypothermic
perfusion with University of Wisconsin solution. The bioenergetic status of
the limbs was monitored by 31phosphorus magnetic-resonance spectroscopy,
and histological evaluation was performed to assess ischemic changes in the
preserved tissue. The pH and tissue levels of adenosine triphosphate
declined three times more slowly in the limbs that were preserved by
pulsatile hypothermic perfusion than in the topically cooled limbs.
Consistent with these findings, the perfused limbs also had less
histological evidence of ischemic injury. The data from this in vitro study
show that pulsatile hypothermic perfusion with University of Wisconsin
solution, in combination with an optimum degree of topical cooling, is
superior to topical cooling alone as a method of preserving the
bioenergetic status of amputated limbs.
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