The effects of prolonged ischaemia and subsequent reperfusion during and after reconstructive microsurgery on energy metabolism were studied. Repeated skeletal muscle biopsies were taken and analysed for high energy phosphates and their degradation products by high performance liquid chromatography and for lactate by a fluorometric procedure. Moderate changes in adenine nucleotides occurred during the first 4 h of ischaemia. After 6 h of ischaemia, when the creatine phosphate store was almost depleted and the lactate level had increased to 111 mmol kg-1 dry muscle, ATP content decreased and inosine monophosphate started to accumulate. The inosine monophosphate accumulation was however small, in spite of a high lactate level, which suggests that the increase in H+ associated with lactate formation is not important for the activation of AMP-deaminase during the present conditions. In spite of the accelerating metabolic deterioration during the later period of ischaemia, the reperfusion of the muscle resulted in a rapid normalization of all the studied metabolites, thereby indicating a rapid restoration of the muscle energy stores.