The triphasic pattern of skeletal muscle blood flow in reperfusion injury: an experimental model with implications for surgery on the acutely ischaemic lower limb.

A new model of acute lower limb ischaemia has been developed in the rat hind limb. The model has been used to examine the influence on skeletal muscle blood flow of increasing periods of ischaemia and reperfusion. Following restoration of blood flow after 2-6h ischaemia initial gastrocnemius muscle blood flow was reduced. The severity of initial low reflow, indicated by mean perfusion ratios at 0 and 10 min, correlated with the duration of preceding ischaemia (r = 0.83, p less than 0.05) and was greatest in limbs subjected to 6h ischaemia (p less than 0.01 vs. controls at 0, 10 and 60 min after revascularisation). After 60-240 min, reperfusion muscle blood flow returned to normal in limbs subjected to 3, 4 or 5 h ischaemia. In contrast, peak muscle blood flow in limbs that had been ischaemic for 6 h occurred after 120 min, although perfusion remained less than that measured in control limbs (p less than 0.05:6 h ischaemia, 120 min vs. control)-(relative reperfusion). Limbs reperfused after 6 h ischaemia demonstrated a subsequent decline in muscle blood flow between 120 min and 240 min following revascularisation (p less than 0.05). In addition, muscle blood flow at 240 min was no different to that in a totally ischaemic limb (p less than 0.01 vs. controls; ns vs. ischaemic limb) thus representing reperfusion injury.