Added Value of Histological Evaluation of Muscle Biopsies in Porcine Vascularized Composite Allografts.

: Machine perfusion (MP) offers extended preservation of vascularized complex allografts (VCA), but the diagnostic value of histology using hematoxylin and eosin (H&E) in detecting ischemia-reperfusion injury (IRI) in muscle cells remains unclear. This study aims to document the application of the Histology Injury Severity Score (HISS) and to assess whether additional staining for nicotinamide adenine dinucleotide (NADH) and membrane attack complex (MAC) improves IRI detection in a porcine limb replantation model. : The forelimbs of 16 Dutch Landrace pigs were amputated and preserved for 24 h using hypothermic MP ( = 8) with Histidine-Tryptophan-Ketoglutarate (HTK) or for 4 h with SCS ( = 8) before heterotopic replantation and 7 days of follow-up.