Combat and mass casualty situations, particularly where detonations have occurred, invariably produce a significant amount of soft tissue damage and can be associated with extremity avulsion.  In order to optimize recovery of the patient and facilitate return to duty, the best options remain replantation or transplantation of the avulsed tissue and extremity.  However, for replantation to be a viable option, the patient must be stabilized and transported to an advanced care facility. This means the avulsed extremity needs to be preserved for several hours or even days. Unfortunately, skeletal muscle will not remain viable for more than 6 hours at normothermia due to the onset of ischemia induced necrosis.¹   Tissue degradation ultimately leads to loss of cell homeostasis, releasing a multitude of factors that prime the tissue for free radical production leading to irreversible ischemic and reperfusion injuries.^1,2  Thus, replantation of large limbs that have experienced prolonged ischemia may result in a number of serious complications.