Sympathetic innervation does not contribute to glycerol release in ischemic flaps

Abstract

Background. Extracellular glycerol as detected by microdialysis has been used as a surrogate marker for (ischemic) tissue damage and cellular membrane breakdown in the monitoring of free microvascular musculocutaneous flaps. One confounding factor for glycerol as a marker of ischemic cell damage is the effect of lipolysis and associated glycerol release as induced by sympathetic signalling alone. We hypothesized that extracellular glycerol concentrations in a microvascular flap with sympathetic innervation would be confounded by intact innervation per se as compared to denervated flap. Clinical relevance is related to the use of both free and pedicled flaps in reconstructive surgery. We tested the hypothesis in an experimental model of microvascular musculocutaneal flaps. Methods. Twelve pigs were anesthetized and mechanically ventilated. Two identical rectus abdominis musculocutaneal flaps were raised for the investigation. In the A-flaps the adventitia of the artery and accompanying innervation was carefully stripped, while in the B-flaps it was left untouched. Flap ischemia was induced by clamping both vessels for 60 minutes. The ischemia was confirmed by measuring tissue oxygen pressure, while extracellular lactate to pyruvate ratio indicated the accompanying anaerobic metabolism locally. Results. Intramuscular and subcutaneal extracellular glycerol concentrations were measured by microdialysate analyzer. Contrary to our hypothesis, glycerol concentrations were comparable between the two ischemia groups at 60 minutes (p = 0.089, T-test). Conclusions. In this experimental model of vascular flap ischemia, intact innervation of the flap did not confound ischemia detection by glycerol. Extrapolation of the results to clinical setting warrants further studies.

Key Words::

• Glycerol
• microdialysis
• postoperative monitoring
• free flaps
• pedicled flaps
• flap ischemia

Acknowledgements

This study was funded by departmental research grants.

Some of the data were presented as a poster at The Annual Congress of ESICM, Barcelona 2006. Other sections of the experiment have been reported previously (Nunes S et al., Anesthesia & Analgesia 2007).

Author roles: Leena Berg, Heikki Ahonen, and Ilkka Parviainen: Data collection and conduct of the work. Lassi P. Raittinen, Silvia Nunes, Jussi Laranne, and Jyrki J. Tenhunen: Manuscript preparation, data analysis and study design.

Declaration of interest: JT was an invited speaker in a Microdialysis users’ meeting in Cascais, Portugal 2004 (organizer and the payment of flights: CMA Microdialysis, Stockholm, Sweden). The other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.