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

I.F. Megas, D. Simons, B.S. Kim, C. Stoppe, A. Piatkowski, P. Fikatas, P.C. Fuchs, J. Bastiaanse, N. Pallua, J. Bernhagen, G. Grieb*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


(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.
Original languageEnglish
Article number616
Number of pages9
Issue number6
Publication statusPublished - 1 Jun 2021


  • macrophage migration inhibitory factor (MIF)
  • free flap surgery
  • innovative surgical methods
  • microanastomosis
  • ischemia
  • MIF

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