Do superoxide radicals in blood indicate anastomotic patency after microvascular tissue reperfusion?

Superoxide radicals were measured in the blood of six patients who underwent vascular reconstruction after ischemic injury in an attempt to predict prognosis following surgery. Three free-tissue transfers (two free latissimus dorsi flaps, one free vascularized fibular osteocutaneous graft) were performed on patients with skin or bone defects associated with open tibial fractures. Vascular reconstructions were performed on two patients with popliteal vascular injuries, in one case with an open femoral fracture and in another with an open knee dislocation. A third vascular reconstruction was performed on a patient with a subclavian artery injury associated with a clavicular fracture. Superoxide levels in the blood were quantified by a chemiluminescence method using a derivative of luciferin. Blood was obtained prior to reperfusion and periodically to 72 hr postoperatively. In patients who underwent successful reconstructions, superoxide levels increased after reperfusion. Vascular insufficiency was associated with acute drops in superoxide concentrations. Superoxide levels are a promising clinical marker which can predict insufficiency during reperfusion following tissue ischemia.