{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:45:24Z","timestamp":1793148324519,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","license":[{"start":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T00:00:00Z","timestamp":1724025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH1910714"],"award-info":[{"award-number":["W81XWH1910714"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH1910714"],"award-info":[{"award-number":["W81XWH1910714"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Continuous extracorporeal perfusion (ECP), or machine perfusion, holds promise for prolonged skeletal muscle preservation in limb ischemia-reperfusion injury. This study aimed to extend the amputation-to-replantation time window from currently 6\u2009hours to 33\u2009hours using a 24-hour ECP approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Six large white pigs underwent surgical forelimb amputation under general anesthesia. After amputation, limbs were kept for 9\u2009hours at room temperature and then perfused by 24-hour ECP with a modified histidine-tryptophan-ketoglutarate (HTK) solution. After ECP, limbs were orthotopically replanted and perfused in vivo for 12\u2009hours. Clinical data, blood, and tissue samples were collected and analyzed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All 6 forelimbs could be successfully replanted and in vivo reperfused for 12\u2009hours after 9\u2009hours of room temperature ischemia followed by 24\u2009hours ECP. Adequate limb perfusion was observed after replantation as shown by thermography and laser Doppler imaging. All pigs survived without severe organ failure, and no significant increase in inflammatory cytokines was found. Macroscopy and histology showed marked interstitial muscular edema of the limbs, whereas myofiber necrosis was not evident, implying the preservation of muscular integrity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The use of a 24-hour ECP has successfully extended limb preservation to 33\u2009hours. The modified histidine-tryptophan-ketoglutarate perfusate demonstrated its ability for muscle protection. This innovative approach not only facilitates limb replantation after combat injuries, surmounting geographical barriers, but also broadens the prospects for well-matched limb allotransplants across countries and continents.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae043","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T12:09:05Z","timestamp":1724069345000},"page":"83-92","source":"Crossref","is-referenced-by-count":10,"title":["Prolongation of the Time Window From Traumatic Limb Amputation to Replantation From 6 to 33 Hours Using Ex Vivo Limb Perfusion"],"prefix":"10.1093","volume":"189","author":[{"given":"Lei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department for BioMedical Research, DBMR, University of Bern , Bern 3008,","place":["Switzerland"]},{"name":"Department of Plastic- and Hand Surgery, Inselspital, Bern University Hospital , Bern 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