Ischemic tolerance of human skeletal muscle.

Until now, the ischemic tolerance of muscle tissue has not been adequately understood. Even when muscle vitality is lost, the perfusion matrix of the muscle flaps is retained. Because of toxic decomposition, however, irreversibly damaged muscle cells almost certainly increase the rate of complications. The retention of the vitality of the transplanted muscle tissue is absolutely essential for the myokinetic substitute operations, currently in the development stage, involving the free transplantation of muscles. Investigations into vitality reserves were carried out on skeletal muscle specimens. Nuclear magnetic resonance spectroscopy was used to establish that, in ischemia, the ATP pool remained topped up to a large extent as long as phosphocreatine was available. As long as the ATP pool was retained, rearterialization led to the complete restoration of the essential preischemic metabolite concentrations. After the ATP had been exhausted, biochemical restitution through arterial reperfusion did not occur. The time by which the established vitality threshold was reached because of the loss of the ATP pool is called the critical ischemia time; it depends on muscle temperature. The critical ischemia time of human skeletal muscles was determined between 26 degrees and 38 degrees C. A normothermia of 34 degrees C yielded a critical ischemia time of 2.25 hours, which is shorter than that previously reported in the literature. An ischemic tolerance of 5 hours presupposes a muscle temperature of less than 26 degrees C.