THE ROLE OF CELLULAR ADHESION MOLECULES IN SURGERY

The purpose of this review is to detail the roles played by the cellul ar adhesion molecules (CAM) in inflammatory and immunological reaction s relevant to surgery. The interactions between leucocytes and endothe lial cells which are mediated by CAM are central to the development of ischaemia/reperfusion injury (IRI) as occurs when blood flow is resto red after an ischaemic period; for example, following revascularizatio n of replanted digits and microvascular tissue transfers, angioplasty and tourniquet procedures. Cellular adhesion molecules are also import ant in wound healing and other inflammatory processes. In addition, th e immunological response to organ allograft transplantation is mediate d by cellular interactions mediated by CAM. This review details the fu nctions and regulation of the various CAM involved in inflammation and allograft rejection and summarizes the results of previous surgical s tudies in which various techniques have been used to block the interac tions mediated by CAM in an attempt to improve surgical outcomes.