Primary and secondary critical ischemia times of myocutaneous flaps

The primary critical ischemia time of the latissimus dorsi myocutaneous flap model was determined in the pig. Latissimus dorsi flaps were subjected to a primary ischemic insult of 2 hours (mimicking the ischemic event of free-tissue transfer). Following 12 hours of normal flow, the flaps were subjected to a second ischemic insult ranging from 0 to 12 hours. The secondary critical ischemia time (11.3 hours) was found to be statistically comparable to the primary critical ischemia time (9.1 hours). Questions are raised concerning the mechanism of action of this phenomenon and its clinical relevance.