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A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery
Published on: November 8, 2019
Macrophage Migration Inhibitory Factor-An Innovative Indicator for Free Flap Ischemia after Microsurgical
Ioannis-Fivos Megas1, David Simons2, Bong-Sung Kim2,3,4
1Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany.
Abstract:
(1) Background: Nowadays, the use of microsurgical free flaps is a standard operative procedure in reconstructive surgery. Still, thrombosis of the microanastomosis is one of the most fatal postoperative complications. Clinical evaluation, different technical devices and laboratory markers are used to monitor critical flap perfusion. Macrophage migration inhibitory factor (MIF), a structurally unique cytokine with chemokine-like characteristics, could play a role in predicting vascular problems and the failure of flap perfusion. (2) Methods: In this prospective observational study, 26 subjects that underwent microsurgical reconstruction were observed. Besides clinical data, the number of blood leukocytes, CRP and MIF were monitored. (3) Results: Blood levels of MIF, C-reactive protein (CRP) and leukocytes increased directly after surgery. Subjects that needed surgical revision due to thrombosis of the microanastomosis showed significantly higher blood levels of MIF than subjects without revision. (4) Conclusion: We conclude that MIF is a potential and innovative indicator for thrombosis of the microanastomosis after free flap surgery. Since it is easy to obtain diagnostically, MIF could be an additional tool to monitor flap perfusion besides clinical and technical assessments.
Insights
Macrophage migration inhibitory factor (MIF) may predict microvascular thrombosis after free flap surgery. Higher MIF levels in patients needing revision indicate its potential as an innovative monitoring tool for flap perfusion.
Area of Science:
- Reconstructive Surgery
- Vascular Biology
- Immunology
Background:
- Microsurgical free flaps are standard in reconstructive surgery.
- Microanastomosis thrombosis is a critical postoperative complication.
- Monitoring flap perfusion involves clinical evaluation, technical devices, and laboratory markers.
Purpose of the Study:
- To investigate the role of Macrophage Migration Inhibitory Factor (MIF) in predicting vascular complications after microsurgical free flap reconstruction.
- To assess MIF as a potential indicator for microanastomosis thrombosis.
Main Methods:
- Prospective observational study of 26 patients undergoing microsurgical reconstruction.
- Monitoring of clinical data, blood leukocytes, C-reactive protein (CRP), and MIF levels.
- Comparison of MIF levels between patients with and without surgical revision for thrombosis.
Main Results:
- Postoperative increases in MIF, CRP, and leukocyte levels were observed.
- Patients requiring surgical revision for microanastomosis thrombosis exhibited significantly higher MIF levels.
- MIF levels correlated with the occurrence of thrombosis.
Conclusions:
- Macrophage Migration Inhibitory Factor (MIF) shows potential as an innovative indicator for microanastomosis thrombosis post-free flap surgery.
- MIF is a readily obtainable diagnostic marker.
- MIF can serve as an additional tool for monitoring flap perfusion alongside existing methods.
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