Brigham and Women’s doctor aims to improve viability of severed limbs

Bohdan Pomahac has a developed a device he hopes will help patients who have lost limbs.

Bohdan Pomahac holds his Stepping Strong Innovator Award. —Lightchaser Photography and Consulting Llc image by j. kiely jr. © 2015 photograph

Gillian Reny was 18 years old when she was rushed to Brigham and Women’s Hospital in 2013 with life-threatening injuries. The aspiring dancer had been standing with her parents near the finish line of the Boston Marathon.

The doctors at Brigham and Women’s were able to save her life and both her legs. Her family established a fund at the hospital — the Gillian Reny Stepping Strong Fund — in her honor to support research that would help future patients with traumatic limb injuries.

Now, a team of researchers at Brigham and Women’s are trying to improve the process for treating traumatic limb injuries, like those seen after the marathon bombing.

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Currently, doctors have about four to six hours to reattach a limb after it has been severed from the body, according to Bohdan Pomahac, director of plastic surgery transplantation and the burn center at Brigham and Women’s.

“One of the biggest hurdles is that the four hour window is too short,’’ he said. “If you are in Afghanistan or somewhere in the midwest in a field where accidents occur, it’s often not easy or possible to get that particular person to a major academic medical center that has the capacity to put that limb back on.’’

But Pomahac has developed a portable device that he hopes will keep limbs alive for a longer period than is currently possible using cold storage.

Pomahac said he began working on a perfusion machine about four or five years ago, and now he and his research team have a device that can keep a limb alive for up to 12 hours.

“Our hope would be that we can develop technology that will allow essentially anyone injured who has lost limbs — whether it’s in a war or car accident or any other trauma — that will allow enough time to transfer these patients to medical centers where putting the limb back on would be achievable,’’ Pomahac said.

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The device is the size of a couple of briefcases stacked on top of each other. The limb is placed on a tray towards the top of the device where it is attached to a pump that delivers a solution containing electrolytes, compounds, and oxygen. Sensors deliver feedback on the health of the limb as the solution runs through the detached body part and gets collected, filtered, and run through again.

The device. —Screenshot Brigham & Women’s Steeping Strong Innovator Award video

“It’s something that two people could carry on to an ambulance, transfer it by helicopter, including the limb inside,’’ Pomahac said. “So it’s been designed with the intent of having something portable that could be used in a war zone that could be used anywhere essentially, in an ambulance, it could sit in different ways to different places, field hospitals, etc.’’

The enlarged window for limb viability could help physicians in mass-casualty events like the Boston Marathon bombing, Pomahac said, since even the best trauma teams have to start triaging and prioritizing. Limbs could be put in the perfusion machine, giving doctors time to focus on saving the patient, and the limbs could be gotten to 10 or 12 hours later.

“It creates the opportunity to save patients who otherwise would not be able to get there,’’ he said.

With the increase from four to 12 hours, the geographical window, and chance, for patients looking for transplant donor is also increased, Pomahac said.

But he said if the window could be extended to 24 hours, patients could have donors living on other continents.

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“We would be able to globally share donors for transplant,’’ he said.

The device could also potentially be used to treat limbs in isolation, if the medication is too toxic for the rest of the body — like targeting sarcoma in the limb with chemotherapy without affecting the rest of the body, Pomahac said.

“I also hope and I believe that the technology can be used to manipulate the limbs while they’re detached from the human body, “ he said. “You could deliver drugs, you could make the muscle stronger perhaps, you could make them better. You could resuscitate, redirect the tissues, rather than just keep them alive. So I think it gives you a lot of avenues to explore how to improve outcomes for our patients.’’

Earlier this month, Pomahac won the Stepping Strong Innovator Award, receiving $100,000 for his research project “From Battlefield to Bedside: A Portable Device for Rescuing Limbs.’’ The project was selected by members of the public who cast 5,000 votes across 50 states and 74 countries to choose from three finalists.

Pomahac said the receipt of the award is an appreciation of his team’s work and the prize money will help them continue to test the true limit of the device.

He said he and his team picked to test 12 hours before because they thought it couldn’t be accomplished and it would help them define the boundary of the device’s capability.

They were surprised to find that with the device, at 12 hours, the limbs were more viable than the current standard of care.

Now,the team is planning to see if the device can extend to 24 or even 48 hours, though Pomahac said beyond 24 hours is unlikely.

“We’ve been wrong before, so this allows us to do experiments and text our hypotheses to the limit,’’ he said.

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