J Reconstr Microsurg 2009; 25(9): 527-531
DOI: 10.1055/s-0029-1238220
© Thieme Medical Publishers

The Effect of Ischemic Preconditioning on Secondary Ischemia in Myocutaneous Flaps

Asad A. Shah1 , Julio E. Arias2 , J. Grant Thomson2
  • 1Duke University School of Medicine, Durham, North Carolina
  • 2Yale University School of Medicine, New Haven, Connecticut
Further Information

Publication History

Publication Date:
22 September 2009 (online)

ABSTRACT

We sought to determine the effect of ischemic preconditioning (IPC) on secondary ischemia in myocutaneous flaps in a rat model. Forty rectus abdominis myocutaneous flaps were elevated in 40 rats, and the animals were randomized into control or IPC groups (20 flaps each group). All flaps were then subject to primary ischemia for 2 hours via pedicle clamping. Twenty-four hours later, the control and IPC flaps were randomized to two groups each of 1 or 2 hours of secondary ischemia (4 groups, 10 flaps per group). Flap survival was evaluated on postoperative day 5 by measuring the percentage area of flap survival by a blinded observer. Mean flap survival area and total necrosis rates were compared between the groups. In the 1-hour secondary ischemia groups, IPC improved mean flap survival area from 11 ± 7% to 36 ± 22%, and the total necrosis rates from 40 to 0%. These differences were statistically significant (p < 0.006, p < 0.05, respectively). In the 2-hour secondary ischemia groups, differences were not statistically significant (p = 0.2, p = 0.4, respectively). IPC improves the survival of myocutaneous flaps subjected to secondary ischemia of 1 hour in this rat free flap model.

REFERENCES

  • 1 Bui D T, Cordeiro P G, Hu Q Y, Disa J J, Pusic A, Mehrara B J. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps.  Plast Reconstr Surg. 2007;  119 2092-2100
  • 2 Panchapakesan V, Addison P, Beausang E, Lipa J E, Gilbert R W, Neligan P C. Role of thrombolysis in free-flap salvage.  J Reconstr Microsurg. 2003;  19 523-530
  • 3 Brown J S, Devine J C, Magennis P, Sillifant P, Rogers S N, Vaughan E D. Factors that influence the outcome of salvage in free tissue transfer.  Br J Oral Maxillofac Surg. 2003;  41 16-20
  • 4 Nakatsuka T, Harii K, Asato H et al.. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection.  J Reconstr Microsurg. 2003;  19 363-368 discussion 369
  • 5 Yii N W, Evans G R, Miller M J et al.. Thrombolytic therapy: what is its role in free flap salvage?.  Ann Plast Surg. 2001;  46 601-604
  • 6 Khouri R K, Cooley B C, Kunselman A R et al.. A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg. 1998;  102 711-721
  • 7 Kroll S S, Schusterman M A, Reece G P et al.. Timing of pedicle thrombosis and flap loss after free-tissue transfer.  Plast Reconstr Surg. 1996;  98 1230-1233
  • 8 Pohlenz P, Blessmann M, Blake F, Li L, Schmelzle R, Heiland M. Outcome and complications of 540 microvascular free flaps: the Hamburg experience.  Clin Oral Investig. 2007;  11 89-92
  • 9 Picard-Ami Jr L A, Thomson J G, Kerrigan C L. Critical ischemia times and survival patterns of experimental pig flaps.  Plast Reconstr Surg. 1990;  86 739-743 discussion 744-745
  • 10 Khalil A A, Aziz F A, Hall J C. Reperfusion injury.  Plast Reconstr Surg. 2006;  117 1024-1033
  • 11 Zahir K S, Syed S A, Zink J R, Restifo R J, Thomson J G. Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model.  Plast Reconstr Surg. 1998;  102 140-150 discussion 151-152
  • 12 Marian C F, Jiga L P, Ionac M. Ischemic preconditioning of free muscle flaps: an experimental study.  Microsurgery. 2005;  25 524-531
  • 13 Steenbergen C, Perlman M E, London R E, Murphy E. Mechanism of preconditioning. Ionic alterations.  Circ Res. 1993;  72 112-125
  • 14 Liu G S, Thornton J, Van Winkle D M, Stanley A WH, Olsson R A, Downey J M. Protection against infarction afforded by preconditioning is mediated by A1 adenosine receptors in rabbit heart.  Circulation. 1991;  84 350-356
  • 15 Pang C Y, Forrest C R, Mounsey R. Pharmacologic intervention in ischemia-induced reperfusion injury in the skeletal muscle.  Microsurgery. 1993;  14 176-182
  • 16 Moses M A, Addison P D, Neligan P C et al.. Mitochondrial KATP channels in hindlimb remote ischemic preconditioning of skeletal muscle against infarction.  Am J Physiol Heart Circ Physiol. 2005;  288 H559-H567
  • 17 Küntscher M V, Juran S, Altmann J, Menke H, Gebhard M M, Germann G. Role of nitric oxide in the mechanism of preclamping and remote ischemic preconditioning of adipocutaneous flaps in a rat model.  J Reconstr Microsurg. 2003;  19 55-60
  • 18 Hopper R A, Forrest C R, Xu H et al.. Role and mechanism of PKC in ischemic preconditioning of pig skeletal muscle against infarction.  Am J Physiol Regul Integr Comp Physiol. 2000;  279 R666-R676
  • 19 Murry C E, Jennings R B, Reimer K A. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium.  Circulation. 1986;  74 1124-1136
  • 20 Coskunfirat O K, Ozkan O, Dikici M B. The effect of ischemic preconditioning on secondary ischemia in skin flaps.  Ann Plast Surg. 2006;  57 431-434
  • 21 Moses A M, Addison P D, Neligan P C et al.. Inducing late phase of infarct protection in skeletal muscle by remote preconditioning: efficacy and mechanism.  Am J Physiol Regul Integr Comp Physiol. 2005;  289 R1609-R1617
  • 22 Zahir T M, Zahir K S, Syed S A, Restifo R J, Thomson J G. Ischemic preconditioning of musculocutaneous flaps: effects of ischemia cycle length and number of cycles.  Ann Plast Surg. 1998;  40 430-435
  • 23 Dassonville O, Poissonnet G, Chamorey E et al.. Head and neck reconstruction with free flaps: a report on 213 cases.  Eur Arch Otorhinolaryngol. 2008;  265 85-95
  • 24 Addison P D, Neligan P C, Ashrafpour H et al.. Noninvasive remote ischemic preconditioning for global protection of skeletal muscle against infarction.  Am J Physiol Heart Circ Physiol. 2003;  285 H1435-H1443
  • 25 Jackiewicz T A, McGeachie J K, Tennant M. Structural recovery of small arteries following clamp injury: a light and electron microscopic investigation in the rat.  Microsurgery. 1996;  17 674-680

J. Grant ThomsonM.D. M.Sc. 

Yale Plastic Surgery, PO Box 208041

New Haven, CT 06520-8041

Email: grant.thomson@yale.edu