Intervention approaches against I/R-induced arterial insufficiency in reconstructive surgery

Ischemia and reperfusion in skeletal muscle is unavoidable during many reconstructive surgeries. Typical examples include replantation, transplantation, and free muscle transfer. One important complication during or after surgery is arterial insufficiency or a no-reflow phenomenon. The microcirculation is a primary target of ischemia and reperfusion injury. Vasoconstriction, poor blood flow, and capillary no-reflow, are the prominent features in the microcirculation seen during reperfusion. Currently, extensive efforts have focused on the theory that reactive oxygen species induce endothelial dysfunction in the microcirculation during reperfusion. Some intervention approaches, including ischemic preconditioning, are developing to interfere with or modulate the pathophysiological processes that are set in motion during ischemia and reperfusion.