This report (1) summarizes our current understanding of the nature of the revascularization syndrome and defines the patients most vulnerable to such damage, (2) details the principles for avoiding the revascularization syndrome evolving from our experimental work in the field of ischemic and reperfused skeletal muscle, (3) presents the clinical applicability of controlled reperfusion in skeletal muscle and our initial experience in patients, and (4) points to unresolved problems in the field of skeletal muscle protection.