{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:38:58Z","timestamp":1747150738492,"version":"3.40.5"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Replantation of amputated limbs after long ischemic hours almost always comes with reperfusion syndrome and poor outcomes. An ischemic time of greater than 6\u2009h is often considered unsuitable for major limb replantation. However, usage of extracorporeal perfusion has been shown to prolong the viability of major limbs in animal studies. The aim of this report is to show that extracorporeal perfusion with cardiopulmonary bypass machine (CPBM) is a safe and reliable technique in improving limb survival as illustrated by our cases. We report two cases of successful major limb replantation with late presentation. One case involved a 31\u2010year\u2010old man with shoulder disarticulation and the other involved a 30\u2010year\u2010old man sustained proximal transtibial amputation. Both patients, who were generally fit, were involved in major road traffic accidents. The amputated segments were connected to a CPBM to expedite reperfusion and to flush away anaerobic metabolic products. The major vessels were cannulated and connected to a bypass machine that was initially primed with heparinized saline and perfused with packed cells at 100% oxygen concentration. The perfusion was carried out at 35\u00b0C with low pressure to prevent edema and low flow to reduce reperfusion injury. Venous blood was drained completely before replantation. Total ischemia times were 7\u2009h 40\u2009min and 9\u2009h, respectively. No evidences of perioperative reperfusion syndrome were seen. Both of the replanted limbs survived and patients had regained better\u2010than\u2010expected limb functional outcomes at 5\u2010year and 2\u2010year follow\u2010up, respectively. CPBM may be safely used in major replantation surgery to enhance limb survival and therefore warrants further research.<\/jats:p>","DOI":"10.1002\/micr.31086","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T07:20:37Z","timestamp":1688973637000},"page":"722-729","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The heart\u2010lung machine in major limb replantation: Report of two cases"],"prefix":"10.1002","volume":"43","author":[{"given":"Wan Faisham Numan B.","family":"Wan Ismail","sequence":"first","affiliation":[{"name":"Department of Orthopaedic, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kota Bharu Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Azman","family":"Bin Wan Sulaiman","sequence":"additional","affiliation":[{"name":"Department of Reconstructive Sciences, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arman Zaharil Bin Mat","family":"Saad","sequence":"additional","affiliation":[{"name":"Plastic &amp; Reconstructive Unit, MSUMC, Management and Science University, University Drive Off Persiaran Olahraga  Shah Alam Selangor Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariffin Marzuki Bin","family":"Mokthar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kota Bharu Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Bin","family":"Paiman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kota Bharu Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Hanifah Bin","family":"Jusoh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kota Bharu Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad Zuhdi Bin","family":"Mamat","sequence":"additional","affiliation":[{"name":"Cardiothoracic Unit, Department of Surgery, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-4519","authenticated-orcid":false,"given":"Chong Soon","family":"Eu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Hospital USM, School of Medical Sciences, Health Campus Universiti Sains Malaysia  Kota Bharu Kelantan Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2017.09.013"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0967-2109(02)00070-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fchem.2020.00732"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200111000-00030"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1262951"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2016.43.6.544"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_201905_17955"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40779-020-00250-y"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30649"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006084"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.09.012"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2003.008797"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0203000113"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30739"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-024-1625-1"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003226"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.05.055"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2019.12.005"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T07:35:43Z","timestamp":1697528143000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":18,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/micr.31086"],"URL":"https:\/\/doi.org\/10.1002\/micr.31086","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"type":"print","value":"0738-1085"},{"type":"electronic","value":"1098-2752"}],"subject":[],"published":{"date-parts":[[2023,7,10]]},"assertion":[{"value":"2022-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}