Most of the methods available for postoperative monitoring of free transfers depend on an accessible skin island. Monitoring of muscle transfers without skin islands represents a challenge. The aim of this study was to describe the experiences after clinical monitoring of free muscle transfers by the use of microdialysis. The charts of 75 free muscle transfers monitored with microdialysis were evaluated with special emphasis on whether or not complications were predicted by the monitoring system. In 16 of the 75 cases, an ischemic trend was seen. In five of these cases, the ischemic trend was reversed without surgical revascularization. In the remaining 11 cases (14.7%), further ischemic trends were seen, and surgical revision with revascularization was needed for transfer salvage. Six of the 11 transfers were subsequently saved. None of the remaining five transfers were lost due to neglected ischemia. The microdialysis system did not exhibit any negative or positive false alarms. No damage to the muscle flap was experienced while performing the monitoring procedures. Microdialysis is a reliable and safe monitoring method for surveillance of free muscle transfers.

13 Huang Q, Neuenschwander PF, Rezaie AR, Morrissey JH. Substrate recognition by tissue factor-factor VIIa. Evidence for interaction of residues Lys165 and Lys166 of tissue factor with the 4-carboxyglutamate-rich domain of factor X. J Biol Chem 1996; 271: 21752-7.14 Boettcher JM, Davis-Harrison RL, Clay MC, Nieuwkoop AJ, Ohkubo YZ, Tajkhorshid E, Morrissey JH, Rienstra CM. Atomic view of calcium-induced clustering of phosphatidylserine in mixed lipid bilayers. Biochemistry 2011; 50: 2264-73.Remote ischemic preconditioning reduces thrombus formation in the rat Ischemic preconditioning (IPC) is known to protect tissue from ischemia and has an effect both locally [1] and systemically [2]. Remote IPC (RIPC) induced by limb ischemia provides systemic protection against prolonged ischemia in the target organ. RIPC has been reported to reduce infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty [3] and is currently being evaluated in patients with ischemic stroke undergoing thrombolysis (NCT00975962). We hypothesized that the reduction in ischemic damage with RIPC could rely on a direct effect on arterial thrombus formation and embolization, and investigated this in a dynamic in vivo rat model of experimental thrombosis [4].Animals were treated according to Danish law on animal experiments. RIPC was induced using a protocol described previously [5]. At the time of surgery, a tourniquet was placed for 10 minutes on the left hind limb. Photographs demonstrating blue coloring of the left paw documented ischemia.Ten millimeters of the femoral artery on the right hind leg were dissected distal to the inguinal ligament. The artery was fixed in a clamp and an arteriotomy was performed comprising one-third of the vessel circumference. The proximal vessel edge was inverted by two 10-0 Nylon sutures exposing full thickness of the vessel wall to the lumen. After clamp release, a thrombus would build up at the arteriotomy site, and fragments of thrombus were seen to detach and embolize downstream. This model of a thrombogenic anastomosis is well established in rats [6,7] and pigs [8].The right femoral artery was placed in a trans-illuminator projecting a light beam through the vessel [8,9]. Recordings with a digital recorder were performed through the microscope for 30 min after clamp release and were analyzed offline in a blinded fashion. The thrombus area was measured as the number of pixels every minute, using special ImageJ based software. (ImageJ 1.45s, NIH, USA). The area was measured for 20 min while the number of emboli was counted manually every minute for 30 min. The area of the thrombus and number of emboli were displayed versus time in a graph. The area under the curve (AUC) for thrombus formation over time was determined. Two independent investigators analyzed 10 random videos (coefficient of variation was 21% for counting emboli and 8% for area measurement).Data were consistent with a Gaussian distribution, and the unpaired t-test was used for comparison of the two g...

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