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Berkane Y, Cascales JP, Roussakis E, Lellouch AG, Slade J, Bertheuil N, Randolph MA, Cetrulo CL, Evans CL, Uygun K. Continuous oxygen monitoring to enhance ex-vivo organ machine perfusion and reconstructive surgery. Biosens Bioelectron 2024; 262:116549. [PMID: 38971037 DOI: 10.1016/j.bios.2024.116549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Continuous oxygenation monitoring of machine-perfused organs or transposed autologous tissue is not currently implemented in clinical practice. Oxygenation is a critical parameter that could be used to verify tissue viability and guide corrective interventions, such as perfusion machine parameters or surgical revision. This work presents an innovative technology based on oxygen-sensitive, phosphorescent metalloporphyrin allowing continuous and non-invasive oxygen monitoring of ex-vivo perfused vascularized fasciocutaneous flaps. The method comprises a small, low-energy optical transcutaneous oxygen sensor applied on the flap's skin paddle as well as oxygen sensing devices placed into the tubing. An intermittent perfusion setting was designed to study the response time and accuracy of this technology over a total of 54 perfusion cycles. We further evaluated correlation between the continuous oxygen measurements and gold-standard perfusion viability metrics such as vascular resistance, with good agreement suggesting potential to monitor graft viability at high frequency, opening the possibility to employ feedback control algorithms in the future. This proof-of-concept study opens a range of research and clinical applications in reconstructive surgery and transplantation at a time when perfusion machines undergo rapid clinical adoption with potential to improve outcomes across a variety of surgical procedures and dramatically increase access to transplant medicine.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Shriners Children's, Boston, 02114, MA, USA; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Juan Pedro Cascales
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA; Departamento de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Emmanuel Roussakis
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Julian Slade
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Mark A Randolph
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Conor L Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA.
| | - Korkut Uygun
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA.
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Lu R, Sun F, Zhang L, Zhang C, Du J, Hao J, Zhao L. Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique. Quant Imaging Med Surg 2024; 14:958-971. [PMID: 38223077 PMCID: PMC10784053 DOI: 10.21037/qims-23-1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
Background MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I-II membranous nephropathy (MN). Methods Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05. Results VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89-0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79-0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64-0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43-0.84). Conclusions MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.
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Affiliation(s)
- Renjie Lu
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Fangfang Sun
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lili Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Chao Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jie Du
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jianxun Hao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lirong Zhao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
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Berkane Y, Lellouch AG, Goudot G, Shamlou A, Filz von Reiterdank I, Goutard M, Tawa P, Girard P, Bertheuil N, Uygun BE, Randolph MA, Duisit J, Cetrulo CL, Uygun K. Towards Optimizing Sub-Normothermic Machine Perfusion in Fasciocutaneous Flaps: A Large Animal Study. Bioengineering (Basel) 2023; 10:1415. [PMID: 38136006 PMCID: PMC10740951 DOI: 10.3390/bioengineering10121415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Machine perfusion has developed rapidly since its first use in solid organ transplantation. Likewise, reconstructive surgery has kept pace, and ex vivo perfusion appears as a new trend in vascularized composite allotransplants preservation. In autologous reconstruction, fasciocutaneous flaps are now the gold standard due to their low morbidity (muscle sparing) and favorable functional and cosmetic results. However, failures still occasionally arise due to difficulties encountered with the vessels during free flap transfer. The development of machine perfusion procedures would make it possible to temporarily substitute or even avoid microsurgical anastomoses in certain complex cases. We performed oxygenated acellular sub-normothermic perfusions of fasciocutaneous flaps for 24 and 48 h in a porcine model and compared continuous and intermittent perfusion regimens. The monitored metrics included vascular resistance, edema, arteriovenous oxygen gas differentials, and metabolic parameters. A final histological assessment was performed. Porcine flaps which underwent successful oxygenated perfusion showed minimal or no signs of cell necrosis at the end of the perfusion. Intermittent perfusion allowed overall better results to be obtained at 24 h and extended perfusion duration. This work provides a strong foundation for further research and could lead to new and reliable reconstructive techniques.
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Affiliation(s)
- Yanis Berkane
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Rennes, Université de Rennes, 35000 Rennes, France; (P.G.); (N.B.); (J.D.)
- Shriners Children’s Boston, Boston, MA 02114, USA
- SITI Laboratory, UMR1236, INSERM, Université de Rennes, 35000 Rennes, France
| | - Alexandre G. Lellouch
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, 75006 Paris, France
| | - Guillaume Goudot
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
- INSERM U970 PARCC, Université Paris Cité, 75000 Paris, France
| | - Austin Shamlou
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
| | - Irina Filz von Reiterdank
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02115, USA
- University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - Marion Goutard
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
- SITI Laboratory, UMR1236, INSERM, Université de Rennes, 35000 Rennes, France
| | - Pierre Tawa
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
| | - Paul Girard
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Rennes, Université de Rennes, 35000 Rennes, France; (P.G.); (N.B.); (J.D.)
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Rennes, Université de Rennes, 35000 Rennes, France; (P.G.); (N.B.); (J.D.)
- SITI Laboratory, UMR1236, INSERM, Université de Rennes, 35000 Rennes, France
| | - Basak E. Uygun
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Mark A. Randolph
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
| | - Jérôme Duisit
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU de Rennes, Université de Rennes, 35000 Rennes, France; (P.G.); (N.B.); (J.D.)
- Iris South Hospitals, 1040 Brussels, Belgium
| | - Curtis L. Cetrulo
- Division of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA 02114, USA; (A.G.L.); (I.F.v.R.); (M.G.); (P.T.); (M.A.R.)
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
| | - Korkut Uygun
- Harvard Medical School, Boston, MA 02115, USA;
- Shriners Children’s Boston, Boston, MA 02114, USA
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02115, USA
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Chrelias T, Berkane Y, Rousson E, Uygun K, Meunier B, Kartheuser A, Watier E, Duisit J, Bertheuil N. Gluteal Propeller Perforator Flaps: A Paradigm Shift in Abdominoperineal Amputation Reconstruction. J Clin Med 2023; 12:4014. [PMID: 37373707 DOI: 10.3390/jcm12124014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Abdominoperineal amputation (AAP) is a gold standard procedure treating advanced abdominal and pelvic cancers. The defect resulting from this extensive surgery must be reconstructed to avoid complications, such as infection, dehiscence, delayed healing, or even death. Several approaches can be chosen depending on the patient. Muscle-based reconstructions are a reliable solution but are responsible for additional morbidity for these fragile patients. We present and discuss our experience in AAP reconstruction using gluteal-artery-based propeller perforator flaps (G-PPF) in a case series. Between January 2017 and March 2021, 20 patients received G-PPF reconstruction in two centers. Either superior gluteal artery (SGAP)- or inferior artery (IGAP)-based perforator flaps were performed depending on the best configuration. Preoperative, intraoperative, and postoperative data were collected. A total of 23 G-PPF were performed-12 SGAP and 11 IGAP flaps. Final defect coverage was achieved in 100% of cases. Eleven patients experienced at least one complication (55%), amongst whom six patients (30%) had delayed healing, and three patients (15%) had at least one flap complication. One patient underwent a new surgery at 4 months for a perineal abscess under the flap, and three patients died from disease recurrence. Gluteal-artery-based propeller perforator flaps are an effective and modern surgical procedure for AAP reconstruction. Their mechanic properties, in addition to their low morbidity, make them an optimal technique for this purpose; however, technical skills are needed, and closer surveillance with patient compliance is critical to ensure success. G-PPF should be widely used in specialized centers and considered a modern alternative to muscle-based reconstructions.
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Affiliation(s)
- Theodoros Chrelias
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
| | - Etienne Rousson
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Korkut Uygun
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Alex Kartheuser
- Colorectal Surgery Unit, Department of Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Department of Plastic and Reconstructive Surgery, Hôpitaux IRIS Sud, 1050 Brussels, Belgium
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, South Hospital, CHU Rennes, University of Rennes 1, 35700 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Shriners Children's Boston, Harvard Medical School, Boston, MA 02115, USA
- MICMAC, UMR INSERM U1236, Rennes University Hospital, 35033 Rennes, France
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