Development of a Novel Multi-Stage Limb Salvage Technology for the optimisation of tissue viability in severely injured limbs.

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Objectives:To develop an integrated technology for the preservation of tissue in injured limbs as a result of battlefield injury or severe trauma. The overall objective is to stabilise the casualty and to enhance tissue viability during the evacuation process using novel technologies founded on techniques employed for tissue preservation in other ranches of medicine such as cardiac surgery and organ transportation. The fundamental research question being addressed by this research is "Does rapid isolation and cooling of limbs at the point of injury, combined with isolated perfusion, enhance tissue viability and ultimate limb recovery?"Novel engineering:The project will focus on the impact of combined novel alternating pneumatic tourniquet and topical gas cooling of the tissues on tissue viability in a simulated casualty evacuation environment. The preserved limbs are then placed on an extracorporeal circulatory support system with an automated control system to re-establish perfusion to the limbs with adequacy of circulation monitored using tissue oximetry and laser Doppler flow measurement. The impact of the preservation technique is assessed using nerve stimulation and histological assessment after a period of perfusion. The results of the end stage assessment is used to inform decisions regarding the factors influencing the adequacy of the early preservation steps. Additional in-vitro experiments are carried out to assess the temperature profile of isolated tissue under differing cooling conditions, using infra-red thermal camera techniques. Using this approach, we are able to interpret the positive and potential negative impact of thermal prorogation on tissue preservation to tune the cooling cycle, for example to prevent surface frost bite as a consequence of the technique. This use of these various investigative techniques, combined with the development of new portable tissue preservation technologies are represent an entirely novel engineering approach in this field of emergency medicine.