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The strategies included a balanced crystalloid solution, a colloid, and a combination of crystalloid and resveratrol. Free flap vitality was continuously monitored using hyperspectral imaging and blood gas analysis, comparing intraflap venous blood with central venous blood. The crystalloid group most effectively maintained higher oxygen saturation and lower lactate levels. Conversely, the colloid group exhibited lower tissue oxygen saturation and higher lactate levels. The combination of crystalloid and resveratrol stabilized the hemoglobin and tissue water indices. The study demonstrated a significant influence of different fluid resuscitation strategies on metabolic and perfusion outcomes of free flaps under septic conditions. Administration of crystalloid suggests optimized oxygen delivery and utilization, whereas the combination with resveratrol provided an improved balance of blood volume and hydration, hence preventing fluid overload.<\/jats:p>","DOI":"10.1038\/s41684-026-01747-0","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:04:00Z","timestamp":1779267840000},"page":"314-326","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating perfusion and metabolic responses of microvascular free flaps to ischemia, reperfusion and fluid resuscitation during septic shock in a large animal model"],"prefix":"10.1038","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2480-1231","authenticated-orcid":false,"given":"Daniel","family":"Stephan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Ziebart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ruemmler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Renz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Al-Nawas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Blatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peer. 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