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. 2021 May 21;9(6):616.
doi: 10.3390/healthcare9060616.

Macrophage Migration Inhibitory Factor-An Innovative Indicator for Free Flap Ischemia after Microsurgical Reconstruction

Ioannis-Fivos Megas  1 , David Simons  2 , Bong-Sung Kim  2   3   4 , Christian Stoppe  5 , Andrzej Piatkowski  2   6 , Panagiotis Fikatas  7 , Paul Christian Fuchs  8 , Jacqueline Bastiaanse  1 , Norbert Pallua  2 , Jürgen Bernhagen  3   9   10   11 , Gerrit Grieb  1   2   3
Affiliations

Macrophage Migration Inhibitory Factor-An Innovative Indicator for Free Flap Ischemia after Microsurgical Reconstruction

Ioannis-Fivos Megas et al. Healthcare (Basel). .

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.

Keywords: free flap surgery; innovative surgical methods; ischemia; macrophage migration inhibitory factor (MIF); microanastomosis.

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Conflict of interest statement

Jürgen Bernhagen was supported by Deutsche Forschungsgemeinschaft (DFG) grant BE 1977/11-1 to J.B., by DFG under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy–ID 390857198). Ioannis-Fivos Megas, David Simons, Bong-Sung Kim, Christian Stoppe, Andrzej Piatkowski, Panagiotis Fikatas, Paul Christian Fuchs, Jacqueline Bastiaanse, Norbert Pallua, Jürgen Bernhagen and Gerrit Grieb report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Figures

Figure 1
Figure 1
Postoperative MIF levels. Columns indicate mean values; error bars refer to the corresponding standard deviations (* p ≤ 0.05).
Figure 2
Figure 2
Postoperative levels of leukocytes. Columns indicate mean values; error bars refer to the corresponding standard deviations (* p ≤ 0.05).
Figure 3
Figure 3
Postoperative CRP levels. Columns indicate mean values; error bars refer to the corresponding standard deviations (* p ≤ 0.05; n.s. = not significant).
Figure 4
Figure 4
Postoperative MIF levels divided into two groups. Subjects that needed surgical revision due to thrombosis of the microanastomosis (grey) and subjects without surgical revision (black). Error bars refer to the corresponding standard deviations (* p ≤ 0.05).
Figure 5
Figure 5
Postoperative CRP levels divided into two groups. Subjects that needed surgical revision due to thrombosis of the microanastomosis (grey) and subjects without surgical revision (black). Error bars refer to the corresponding standard deviations (* p ≤ 0.05).
Figure 6
Figure 6
Postoperative levels of leukocytes divided into two groups. Subjects that needed surgical revision due to thrombosis of the microanastomosis (grey) and subjects without surgical revision (black). Error bars refer to the corresponding standard deviations (* p ≤ 0.05).
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