ABSTRACT
The common basic problem with any failing flap is lack of nutrient blood flow. However, a compromised flap can sustain a paradoxical increase in tissue injury after the re-establishment of nutrient blood flow by a phenomenon known as reperfusion injury. Reperfusion injury occurs within seconds of blood flow being re-established to a compromised flap (Fig. 1). The primary cell responsible for reperfusion injury is the neutrophil, which is attracted to ischemic tissue by cytokines. Neutrophils migrate into the flap parenchyma and release free radicals causing cellular injury (1). Compromised reperfused flaps also exhibit the no-reflow phenomenon; the finding that blood flow does not return immediately to some parts of a flap. This is believed to be due to neutrophil plugging; however, the actual cause is unknown.
