Ischemia reperfusion injury has a wide clinical relevance since it influences the outcome of graft and patient survival after reconstructive and transplant procedures. In its classic manifestation, impaired arterial blood supply results in a severe imbalance of metabolic supply and demand, causing tissue hypoxia. Perhaps surprisingly, restoration of blood flow and reoxygenation is commonly associated with an exacerbation of tissue injury and profound inflammatory response. Tissue can be either subjected to periods of cold or warm ischemia, depending on the clinical setting. Cold ischemia typically occurs in transplantation, where tissues are flushed and stored in ice-cold preservation solutions after procurement, whilst warm ischemia occurs during revascularization or following organ traumas such as stroke or myocardial infarction.
The first clue to the existence of ischemic injury was brought up in the 1960s, when it was recognized that the restoration of blood supply after the prolonged clamping of major arteries was followed by systemic shock and acidosis. It is today appreciated that this shock is caused by more than just the âflushing out of toxic metabolitesâ, that accumulate in ischemic tissues. Ischemia and reperfusion injury was first described in 1975 by Cerra et al. upon the findings that the restoration of blood flow to myocardial pedicles in dogs was followed by subendothelial hemorrhagic necrosis. Ischemia and Reperfusion Injury in Reconstructive Transplantation: Barbara Kern and Robert Sucher
Last date updated on June, 2014