Quality assurance in heart surgery. General and personal concepts

Prolonged tissue ischemia and subsequent reperfusion result in significant tissue injury due to the ischemic-reperfusion syndrome. Although skeletal muscle has significant tolerance to ischemic-reperfusion injury (IRI), compared to other organ systems, IRI of skeletal muscle does occur when there is a prolonged ischemic period. In many reconstructive surgical procedures involving microsurgery and prolonged tissue ischemia time, IRI-induced skeletal-muscle injury is a serious clinical concern. Specifically, there are significant vascular complications (venous thrombosis and arteriolar no-reflow) and loss of transplanted muscle function on reperfusion with prolonged ischemia. Ischemic preconditioning (IPC) or adenosine (ADO) pretreatment applied prior to the ischemic period are known to protect against IRI in cardiac muscle. Recent data from basic science research suggest that IPC or ADO pretreatment may be employed to protect skeletal muscle against IRI. This review summarizes the basic mechanisms and potential clinical relevance of ischemia- and reperfusion-induced skeletal muscle injury and describes how skeletal muscle can be protected against IRI with IPC or ADO pretreatment.