ISCHEMIA REPERFUSION-INJURY OF SKELETAL-MUSCLE - PATHOPHYSIOLOGY AND CLINICAL IMPLICATIONS

Ischemia/reperfusion-injuri of skeletal muscle pathophysiology and cli nical implications Ischemia and reperfusion of skeletal muscle occurs in acute vascular occlusion and revascularisation, in elective vascula r surgery! in orthopedic surgery by means of a tourniquet, and in tran splantation of muscle-containing cutaneous flaps. The ischemia sets up a cascade of events, which fully develops not prior to the moment of reperfusion. The ischemia-reperfusion-cascade is comparable to an over whelming inflammatory; reaction out of central. Depending on the durat ion of ischemia it prompts an injury for the muscle itself and in some cases for the whole body. The present review discusses the main mecha nisms of ischemia/reperfusion-injury in terms of cellular metabolism e ndothelial function, cytokine release, and leucocyte function. Release of toxic oxygen radicals by activated leucocytes plays the pivotal ro le in this reaction. In addition, the clinical manifestations of ische mia/reperfusion will be reviewed as well as some of the means proposed to control this harmful reaction.