Yet another debatable topic. Holding solutions are the solutions that the grafts are placed in to sort of “feed” the grafts, stabilize PH, and sometimes protect them from the elements. Some of the holding solutions are: Saline/BSS/DMEM/PLASMALYTE A/BSS with Glutathione/RINGERS LACTATE/ just to name a few and there are others.
Here I hope each representative doctor poster will ask or give input. This is one of my favorite topics because of the physiology aspect. Grafts have a shelf life of 12-24hrs depending on conditions. Here are other interestin facts of other transplantable tissue:
Heart: Has to be beating in another chest within a strict 4 hrs after being cut out of the donor’s chest. Typically stored in UW cold solution. (UW is a solution made by the university of Wisconsin)
Liver: Has to be in recipients chest within 12hrs. Stored in UW.
Lungs: I forgot this one but I suspect similar to heart.
Kidneys: Has 48hrs to be back to making urine. Is either cold storaged or placed on a pump that pumps fluid through it continuously until recipient found. UW is used
Corneas: Can be held for two weeks in it’s holding solution called Optisol GS. The GS is gentamycin sulfate. Optisol GS is unique. Also what is used in eyebanking is BSS or balancing salt solution.
Bones: Are stored in saline and then freezed at -72Celsius
Saphenous veins: Are first injected with papavrin then stored in UW and are processed to be able to use almost indefinitely.
Cooley has much research in this area too. Dr. Cooley’s words below:
Dr. Cooley asked me to post this as it is his quote:
Thanks for the email. I’m on vacation in Italy but maybe you could post this for me. By the way, I’m glad to hear you’re with Harris. He’s a great guy and there you can use all your skills.
Holding solutions…Are they important?
I have used alternative holding solutions for over ten years and have been very interested in this topic. The ‘standard’ holding solutions are normal saline and lactated ringers solution. Careful follicular unit surgery techniques and use of these standard solutions generally results in very good results. The bottom line is that for smaller cases and those lasting less than four to five hours, it may not matter.
In my opinion, using alternative holding solutions could give small but significant improvement in graft survival for cases lasting longer than five hours or greater than 2000 grafts. In our clinic, we place the strip and ‘slivers’ in HypoThermosol at 4-10 degrees celsius. IMO, this provides the greatest protection for grafts outside the body. For dissected grafts waiting to be placed, we put the grafts in cell culture solution (DMEM with HEPES buffer) for protection at room temperature. This solution has glucose, amino acids, buffers to protect the tissue.
Dr Carlos Uebel in Brazil has used a technique with patient derived plasma to create a gel, which is used to coat the grafts before placement. This has growth factors which supposedly speeds up the healing process and revascularization. This is not a ‘holding solution’. It is very interesting but should be considered experimental until more data is available.
Jerry Cooley MD
Charlotte North Carolina"
Thomas Ortiz, BS
James Harris, MD