Perfusion of Free Flaps with Heparinized Whole Blood During Ischemic Storage

ABSTRACT

This study was designed to investigate the use of heparinized whole blood as a perfusate for extending the tolerable ischemic interval of free flaps. Unilateral free groin flaps stored at 20° for 30 hr were used in four groups of 12 rats each. One group served as a control while a second involved systemic heparinization immediately prior to raising the flap for storage. The third and fourth groups underwent a brief perfusion (10-30 min) with anticoagulated whole blood midway through the ischemic interval (15 hr); one of these groups involved temporary revascularization to the arterial system of a donor heparinized rat. The fourth group received hand-perfused anticoagulated (with heparin and citrate) whole blood administered through a cannula placed in the flap artery. After the 30-hr interval, flaps were replanted to the original groin site with standard microvascular technique. Percentages of the numbers of surviving flaps were: 8 percent for controls, 58 percent for both preheparinized and donor-perfused flaps, and 92 percent for the hand-perfused group. The authors conclude that anticoagulated blood within the flap vasculature during ischemic storage can improve the chance for viable reperfusion after replantation, and may offer a safeguard against the no-reflow phenomenon after extended ischemia.