ABSTRACT
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.