Abstract
Objective: Ischemic pre-conditioning and post-conditioning are useful manipulations to reduce the undesirable effects of ischemia-reperfusion skin flap each. But the impact of post-conditioning on the pre-conditioning skin flap is not manifested. Here we investigated the influence of ischemic post-conditioning in a preconditioned axial pattern skin flap model. Method: We used the skin flap in 40 rabbits and divided them into 5 groups randomly. At first we induced the ischemic pre-conditioning of the flap which was applied by 2 periods of 15 minutes of ischemia/15 minutes of reperfusion cycle. Next post-conditioning was performed by 6 cycles of 10 seconds of repeated ischemia/reperfusion periods at different times of just after the reperfusion,5 minutes after the reperfusion,10 minutes after the reperfusion. The animals were allocated into 5 groups: group 1 (Ischemia Group); group 2: (Pre-conditioning Group); group 3: (Pre-conditioning+ Post-conditioning Group); group 4 (Pre-conditioning+ Post-conditioning 5 minutes later Group); group5 (Pre-conditioning+ Post-conditioning 10 minutes later). The neutrophil count was assessed with histologic analysis before the dissection of the skin flap. Flap viability was assessed 1 week after the operation, and surviving flap area was recorded as a percentage of the whole flap area. LSD test was used for statistical analysis among different groups to evaluate the effects of ischemic pre-conditioning against ischemia. Result: Among the varying groups, the neutrophil count varied: Group 1 was50.12±5.91; Group 2, 30.00±2.00, and Group 3, 18.87±3; Group 4, 22.50±1.92; Group 5, 30.12±1.88.The mean± SD surviving areas of the flaps for groups 1, 2, 3, 4 and 5 were 31.76±4.59, 51.26±3.24,82.18±5.28,66.85±3.87 and 51.13±2.90 respectively. Spearman correlation analysis shows an increase relation between neutrophil count and flap survival rate in the different groups (P <0.05). Conclusion: Ischemic post-conditioning has protective effect on ischemic preconditioned skin flaps, but the post-conditioning should be performed within 5 minutes after the end of ischemia.
Highlights
Advances in reconstructive surgery have led to an increasing use of extensive skin flaps for the closure of surgical defects
Free skin flaps are widely used for this purpose
In our previous studies we demonstrated a beneficial effect of tissue post-conditioning on the survival of critically ischemic free skin flaps in new zeweland rabbits
Summary
Advances in reconstructive surgery have led to an increasing use of extensive skin flaps for the closure of surgical defects. Free skin flaps are widely used for this purpose. A new concept has emerged during the past years, which consists of pre-conditioning or post-conditioning the tissue by exposing it to a sub-lethal degree of environmental stress prior to surgery [1,2,3,4,5,6]. During the relieving of the reperfusion injury of the free skin flap, the role of the ischemic pre-conditioning on the skin flap has been proved by Tatlidede S. In our previous studies we demonstrated a beneficial effect of tissue post-conditioning on the survival of critically ischemic free skin flaps in new zeweland rabbits. Whether the ischemic post-conditioning could influence the effect of pre-conditioning skin flap or not has not been confirmed
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