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J Reconstr Microsurg 2006; 22(7): 513-518
DOI: 10.1055/s-2006-951316
REVIEW

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Influence of Transendothelial Mechanisms on Microcirculation: Consequences for Reperfusion Injury after Free Flap Transfer. Previous, Current, and Future Aspects

Andreas Jokuszies1 , Andreas Niederbichler1 , Max Meyer-Marcotty1 , Lars Uwe Lahoda1 , Kerstin Reimers1 , Peter Maria Vogt1
  • 1Department of Plastic and Reconstructive Surgery, Medical School Hannover, Germany
Further Information

Publication History

Accepted: May 17, 2006

Publication Date:
17 October 2006 (online)

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ABSTRACT

The success of a free microvascular tissue transfer is based on a sufficient microanastomosis which meets the following requirements: a pedicle placed without kinking or twisting, good drainage, a well-defined recipient vessel, integrity of the endothelium, and duration of ischemia.

The extent of skin and muscle necrosis increases significantly with increases in ischemia time. Reperfusion of ischemic tissue results in local and systemic damage associated with the release of oxygen free radicals, polymorphonuclear leucocytes, and such endothelial hormones as Endothelin-1, EDRF (endothelial-derived relaxing factor), thromboxane, complement, and cytokines. Ischemia-reperfusion disrupts the delicate balance that maintains homeostasis in the microcirculation.

This review discusses the clinical and therapeutic aspects of such injury, concentrating on perioperative management in free flap transfer. It points out the possible influence of Endothelin-1 on vasospasm at the site of anastomosis, and emphasizes the importance of the endothelium as a highly dynamic network. Finally, future diagnostic and therapeutical aspects are discussed.

KEYWORDS

Reperfusion injury - Endothelin-1 - flap failure

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Andreas JokusziesM.D. 

Klinik für Plastische, Hand- und Wiederherstellungs-chirurgie, Medizinesche Hochschule Hannover

30625 Hannover, Deutschland

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