Patients undergoing reconstructive surgery involving free tissue transfer from one part of the body to another provide an interesting challenge to the anesthetist. The immediate success of this procedure depends on maintainance of adequate perfusion through the microsurgical arterial and venous anastomoses. A technique that optimizes blood flow to the free flap and minimizes the possibility of vascular spasm and flap ischemia is needed. A case is presented in which a patient developed intraoperative flap ischemia. The problem was quickly and reproducibly eliminated by reinjection of an epidural block, thereby possibly preventing loss of the free muscle flap. Case ReportA 53-year-old, 100-kg man with chronic draining osteomyelitis of the right tibia was brought to the operating room for a rectus abdominis free muscle flap transfer to the distal third of the right leg. Preoperative angiography showed patency of only the posterior tibial artery with good distal run-off.Physical evaluation showed a physical status I1 patient with all laboratory values within normal limits. The patient preferred regional anesthesia, and epidural anesthesia was planned.The patient was premedicated with morphine sulfate 10 mg and scopolamine 0.4 mg IM. On amval in the operating room his arterial blood pressure was

A new model of limb xenotransplantation has been developed to determine whether the newer immunosuppressive agents, FK-506 and RS-61443, either alone or in combination, can delay the rejection of a composite limb xenograft from donor Golden Syrian hamsters to recipient Lewis rats. Using a short-term course of immunosuppression for 14 days post-transplant, both FK-506 2 mg/kg/day and RS-61443 30 mg/kg/day were able to delay rejection. FK-506-treated animals had a mean rejection time of 10.2 days and RS-61443-treated animals had a mean rejection time of 10 days, compared with a mean rejection time of 6.4 days in non-immunosuppressed controls. Combination and sequential immunosuppression with both FK-506 and RS-61443 did not produce any improvement, compared with single-agent immunosuppression, and were quite toxic. Histologically, FK-506 seemed to prevent signs of rejection in the skin and muscle components of the limb xenograft better than RS-61443.

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