The Impact of Lidocaine on Secondary Ischemia Injury of Skin Flaps

Abstract

Purpose Lidocaine is used to reduce the undesirable effects of ischemia because of its anti-inflammatory effects. Herein we investigated the effects of lidocaine on secondary ischemia in a skin flap model. Materials and Methods In this epigastric skin flap protocol in animals, we followed 2 hours of primary global ischemia with a reperfusion period of 6 hours and then either secondary arterial or venous ischemia for another 6 hours during which we tested the usefulness of lidocaine. Lidocaine was injected via the intraperitoneal route 5 minutes before the second period of ischemia. The animals were allocated into secondary arterial ischemia or secondary venous ischemia groups which were subdivided according to the delivered agents. Neutrophil cell counts at the margins of the flaps were recorded 12 hours after the end of the second period of ischemia. Flap viability was assessed 1 week after the surgical procedure. Surviving flap area was recorded as the percentage of the whole area. The Least Significant Difference test was used to detect a significant difference among groups, and the Pearson test to evaluate the relationship between neutrophil counts and flap survival rate. Results There were significant differences among groups both with respect to neutrophil count and flap survival. There was a relationship between the neutrophil counts and the flap survivals. Conclusion Intraperitoneally injected lidocaine was an effective procedure to reduce flap necrosis as a cause of secondary ischemia in skin flaps, an effect of the ischemia-reperfusion injury.