The Pathophysiology of Skeletal Muscle Ischemia and the Reperfusion Syndrome: A Review

By W. Blaisdell. Cardiovascular surgery, 2002

705 citations recorded by the source corpus.

There are two components to the reperfusion syndrome, which follows extremity ischemia. The local response, which follows reperfusion. consists of limb swelling with its potential for aggravating tissue injury and the systemic response, which results in multiple organ failure and death. It is apparent that skeletal muscle is the predominant tissue in the limb but also the tissue that is most vulnerable to ischemia. Physiological and anatomical studies show that irreversible muscle cell damage starts after 3 h of ischemia and is nearly complete at 6 h. These muscle changes are paralleled by progressive microvascular damage. Microvascular changes appear to follow rather than precede skeletal muscle damage as the tolerance of capillaries to ischemia vary with the tissue being reperfused. The more severe the cellular damage the greater the microvascular changes and with death of tissue microvascular flow ceases within a few hours—the no reflow phenomenon. At this point tissue swelling ceases. The inflammatory responses following reperfusion varies greatly. When muscle tissue death is uniform, as would follow tourniquet ischemia or limb replantation, little inflammatory response results. In most instances of reperfusion, which follows thrombotic or embolic occlusion, there will be a variable degree of ischemic damage in the zone where collateral blood flow is possible. The extent of this region will determine the magnitude of the inflammatory response, whether local or systemic. Only in this region will therapy be of any benefit, whether fasciotomy to prevent pressure occlusion of the microcirculation, or anticoagulation to prevent further microvascular thrombosis. Since many of the inflammatory mediators are generated by the act of clotting, anticoagulation will have additional benefit by decreasing the inflammatory response. In instances in which the process involves the bulk of the lower extremity, amputation rather than attempts at revascularization may be the most prudent course to prevent the toxic product in the ischemic limb from entering the systemic circulation.

Subfields: Developmental Neuroscience, Pathology and Forensic Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/de908771820c31a6efd5437b321e0ebbddd52cb9

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Citations in the corpus

Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety (2019, background): “Although ischemia-reperfusion injury is most commonly associated with long durations of severe ischemia (Blaisdell, 2002), it is possible that the combination of short duration BFR with muscle contraction could elevate the possibility of muscle damage with this type of exercise.”
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease (2016, background): “The time constraint is due to the period that skeletal 4 to 6 hours (362).”