Reperfusion Injury

Abstract

The restoration of blood flow to ischemic tissues causes additional damage, which is termed reperfusion injury. All tissues are susceptible to reperfusion injury, but this susceptibility varies between tissues. Reperfusion has wide clinical relevance. It influences the outcome of patients after myocardial infarction, stroke, organ transplantation, and cardiovascular surgery. Advances in the treatment of reperfusion injury have created an opportunity for plastic surgeons to apply these treatments to flaps and reimplanted tissues. The main putative mechanisms identified in animal models involve leukocyte-endothelium interactions, reactive oxygen species, and the complement system. However, it has become evident that these fundamental biological systems are controlled by many interrelated pathways. Attempts to bypass this complexity have led to a search for the early "upstream" initiating events, rather than the "downstream" cascading events. This contrasts with current clinical efforts that are directed toward hypothermia, intraarterial flushing, and preconditioning. This article outlines the molecular and cellular events that occur during reperfusion injury and then reviews the efforts that have been made to exploit this knowledge for clinical advantage.

Effects of Systemic Chlorogenic Acid on Random-Pattern Dorsal Skin Flap Survival in Diabetic Rats

“…4) Free radicals may play an important role in ischemic damage, and the generation of reactive oxygen radical species (ROS) in skin flap tissue is one of the mechanisms for flap necrosis. 4,6,7) ROS generation is the major cause of lipid peroxidation, 8) which is aggravated by the presence of diabetes. 4,5) A variety of antioxidant defense systems have been developed by the organism as a protective mechanism against ROS.…”

Gene Expression of the Endothelin-1 in Vasospastic Flap Pedicle – an Experimental Study on a Porcine Model

“…ET-1 is a powerful vasocostrictor. Recent studies proved that ischemia induces an increase of ET-1 mRNA expression and consequently this elevation may cause vasospasm (Tsui et al 2004;Khalil et al 2006).…”

Inflammatory Biomarkers in Ischemic Heart Disease

“…Although timely restoration of blood-flow after a myocardial ischemic event is essential to prevent irreversible cellular injury, it is widely recognized that the outcome of tissue injury not only depends on the duration of the ischemic event, but also on reperfusion as a critical factor (Khalil et al, 2006). Paradoxically, the reperfusion exacerbates severe tissue damage, especially after longer periods of ischemia.…”