An old dream revitalised: preconditioning strategies to protect surgical flaps from critical ischaemia and ischaemia-reperfusion injury

Harder, Yves; Amon, M.; Laschke, Matthias W.; Schramm, René; Rücker, Martin; Wettstein, Reto; Bastiaanse, Jacqueline; Frick, Andreas; Hg, Machens; Küntscher, Markus V.; Germann, G.; Vollmar, Brigitte; Erni, Dominique; Menger, Michael D.

doi:10.1016/j.bjps.2007.11.032

Cited by 94 publications

(67 citation statements)

References 129 publications

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“…In vascular surgery, preconditioning may benefit aortic and extremity reconstructive arterial procedures. In plastic surgery, muscular and myocutaneuos flaps 24 , and also techniques of replantation, free tissue transfer, and composite tissue allotransplantation 25 may be favored.…”

Section: Ischemic Pre and Postconditioning In Skeletal Muscle Injury mentioning

confidence: 99%

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Lintz¹,

Dalio²,

Joviliano³

et al. 2013

Acta Cir. Bras.

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PURPOSE:To investigate the protective effects of ischemic pre and postconditioning, as well as the association of both methods, in skeletal muscle injury produced by ischemia and reperfusion in rats. METHODS:An experimental study was designed using 40 Wistar rats divided in four groups (n=10): Control -rats submitted to ischemia for 240 minutes (min) and reperfusion for 60 min; Ischemic preconditioning (Pre) -animals submitted to three cycles of clamping and releasing the aorta for five min before being submitted to the ischemia/reperfusion procedure; Ischemic postconditioning (Post) -rats submitted to three cycles of clamping and releasing the aorta for one min after the 240-minute ischemic phase; Ischemic pre and postconditioning (Pre-post) -animals submitted to the same procedures of Pre and Post groups. Skeletal muscle injury was evaluated by measuring serum levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CPK); and muscular levels of malondialdehyde (MDA) and glycogen. RESULTS:AST levels were significantly higher in Pre and Pre-post groups (P<.01). There were no differences in LDH and CPK levels. Muscular MDA levels were similar. Glycogen levels were significantly higher in Pre and Pre-post groups (P<.01). CONCLUSIONS:Both preconditioning and its association with postconditioning had a protective effect by avoiding glycogen depletion in skeletal muscle in rats submitted to ischemia and reperfusion. Association of pre and postconditioning did not show advantage compared to preconditioning alone. Postconditioning alone did not show protective effect.

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Section: Ischemic Pre and Postconditioning In Skeletal Muscle Injury mentioning

confidence: 99%

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Lintz¹,

Dalio²,

Joviliano³

et al. 2013

Acta Cir. Bras.

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show abstract

“…Despite a significant progress over the last decades, flap surgery and digit replantation is still associated with considerable morbidity [1]. In this context, tissue ischemia and the consequent ischemic reperfusion injury remain an unsolved problem in transplantation surgery [2].…”

Section: Introductionmentioning

confidence: 99%

Skin Perfusion Changes within 12 h after Axillary Plexus Block

et al. 2017

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Background/Purpose: An improvement of the blood flow would be beneficial in microvascular upper-extremity reconstruction and in digit replantation. In the present work, skin perfusion changes and their duration due to axillary plexus block were quantified. Methods: The peripheral blood flow of the upper extremities in 20 patients undergoing trapeziectomy under axillary plexus block was analyzed. Results: Laser Doppler spectrophotometry was used to measure perfusion factors over a 12-h period, with the contralateral hand acting as the control. Axillary plexus block produced a significant increase of peripheral oxygen saturation (117 ± 35% vs. control 93 ± 22%, p = 0.019), peripheral blood flow (220 ± 166% vs. 130 ± 77%, p = 0.037), and velocity (164 ± 58% vs. 117 ± 45%, p = 0.011). Conclusion: Axillary plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremities over the first 6 h after the inception of anesthesia. This suggests a potential benefit especially for critically perfused tissues.

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“…Although many strategies have been investigated to prevent flap morbidity, including pharmaceutical agents, preconditioning (Küntscher et al, 2002b;Dacho et al, 2009), and postconditioning (Moon et al, 2008;Yan et al, 2010), the total loss of microsurgically transferred flaps is about 1%-5% in experienced hands (Harder et al, 2008). The partial flap necrosis rate is 7%-20% of free flaps and 20%-30% of pedicled flaps.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap

Zhao

Wang

Qin

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs in plastic surgery. The mechanisms of I/R injury include hypoxia, inflammation, and oxidative damage. Hydrogen gas has been reported to alleviate cerebral I/R injury by acting as a free radical scavenger. Here, we assessed the protective effect of hydrogen-rich saline (HRS) on skin flap I/R injury. Methods: Abdominal skin flaps of rats were elevated and ischemia was induced for 3 h; subsequently, HRS or physiological saline was administered intraperitoneally 10 min before reperfusion. On postoperative Day 5, flap survival, blood perfusion, the accumulation of reactive oxygen species (ROS), and levels of cytokines were evaluated. Histological examinations were performed to assess inflammatory cell infiltration. Results: Skin flap survival and blood flow perfusion were improved by HRS relative to the controls. The production of malondialdehyde (MDA), an indicator of lipid peroxidation, was markedly reduced. A multiplex cytokine assay revealed that HRS reduced the elevation in the levels of inflammatory cytokines, chemokines and growth factors, with the exception of RANTES (regulated on activation, normal T-cell expressed and secreted) growth factor. HRS treatment also reduced inflammatory cell infiltration induced by I/R injury. Conclusions: Our findings suggest that HRS mitigates I/R injury by decreasing inflammation and, therefore, has the potential for application as a therapy for improving skin flap survival.

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An old dream revitalised: preconditioning strategies to protect surgical flaps from critical ischaemia and ischaemia-reperfusion injury

Cited by 94 publications

References 129 publications

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Skin Perfusion Changes within 12 h after Axillary Plexus Block

Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap

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