Ioannis-Fivos Megas1, David Simons2, Bong-Sung Kim2,3,4, Christian Stoppe5, Andrzej Piatkowski2,6, Panagiotis Fikatas7, Paul Christian Fuchs8, Jacqueline Bastiaanse1, Norbert Pallua2, Jürgen Bernhagen3,9,10,11, Gerrit Grieb1,2,3. 1. Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany. 2. Burn Center, Department of Plastic Surgery and Hand Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. 3. Institute of Biochemistry and Molecular Cell Biology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. 4. Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. 5. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany. 6. Maastricht University Medical Center, Department of Plastic and Reconstructive Surgery, 6229 HX Maastricht, The Netherlands. 7. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany. 8. Burn Center, Department of Plastic Surgery and Hand Surgery, University of Witten/Herdecke, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109 Köln, Germany. 9. Vascular Biology, Institute for Stroke and Dementia Research (ISD), LMU University Hospital, Ludwig-Maximillian-University (LMU), Feodor-Lynen-Straße 17, 81377 Munich, Germany. 10. German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance, 80336 Munich, Germany. 11. SyNergy Excellence Cluster, 81377 Munich, Germany.
Abstract
(1) Background: Nowadays, the use of microsurgical free flaps is a standard operative procedure in reconstructive surgery. Still, thrombosis of the microanastomosis is one of the most fatal postoperative complications. Clinical evaluation, different technical devices and laboratory markers are used to monitor critical flap perfusion. Macrophage migration inhibitory factor (MIF), a structurally unique cytokine with chemokine-like characteristics, could play a role in predicting vascular problems and the failure of flap perfusion. (2) Methods: In this prospective observational study, 26 subjects that underwent microsurgical reconstruction were observed. Besides clinical data, the number of blood leukocytes, CRP and MIF were monitored. (3) Results: Blood levels of MIF, C-reactive protein (CRP) and leukocytes increased directly after surgery. Subjects that needed surgical revision due to thrombosis of the microanastomosis showed significantly higher blood levels of MIF than subjects without revision. (4) Conclusion: We conclude that MIF is a potential and innovative indicator for thrombosis of the microanastomosis after free flap surgery. Since it is easy to obtain diagnostically, MIF could be an additional tool to monitor flap perfusion besides clinical and technical assessments.
(1) Background: Nowadays, the use of microsurgical free flaps is a standard operative procedure in reconstructive surgery. Still, thrombosis of the microanastomosis is one of the most fatal postoperative complications. Clinical evaluation, different technical devices and laboratory markers are used to monitor critical flap perfusion. Macrophage migration inhibitory factor (MIF), a structurally unique cytokine with chemokine-like characteristics, could play a role in predicting vascular problems and the failure of flap perfusion. (2) Methods: In this prospective observational study, 26 subjects that underwent microsurgical reconstruction were observed. Besides clinical data, the number of blood leukocytes, CRP and MIF were monitored. (3) Results: Blood levels of MIF, C-reactive protein (CRP) and leukocytes increased directly after surgery. Subjects that needed surgical revision due to thrombosis of the microanastomosis showed significantly higher blood levels of MIF than subjects without revision. (4) Conclusion: We conclude that MIF is a potential and innovative indicator for thrombosis of the microanastomosis after free flap surgery. Since it is easy to obtain diagnostically, MIF could be an additional tool to monitor flap perfusion besides clinical and technical assessments.
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