Browse > Article
http://dx.doi.org/10.5999/aps.2017.44.5.384

Effects of Remote Ischemic Conditioning Methods on Ischemia-Reperfusion Injury in Muscle Flaps: An Experimental Study in Rats  

Keskin, Durdane (Department of Plastic, Reconstructive and Aesthetic Surgery, Yuksek Ihtisas University)
Unlu, Ramazan Erkin (Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital)
Orhan, Erkan (Department of Plastic Reconstructive and Aesthetic Surgery, Namik Kemal University)
Erkilinc, Gamze (Department of Pathology, Ankara Numune Training and Research Hospital)
Bogdaycioglu, Nihal (Department of Biochemistry, Ankara Numune Training and Research Hospital)
Yilmaz, Fatma Meric (Department of Biochemistry, Ankara Numune Training and Research Hospital)
Publication Information
Archives of Plastic Surgery / v.44, no.5, 2017 , pp. 384-389 More about this Journal
Abstract
Background The aim of this study was to investigate the effects of remote ischemic conditioning on ischemia-reperfusion injury in rat muscle flaps histopathologically and biochemically. Methods Thirty albino rats were divided into 5 groups. No procedure was performed in the rats in group 1, and only blood samples were taken. A gracilis muscle flap was elevated in all the other groups. Microclamps were applied to the vascular pedicle for 4 hours in order to achieve tissue ischemia. In group 2, no additional procedure was performed. In groups 3, 4, and 5, the right hind limb was used and 3 cycles of ischemia-reperfusion for 5 minutes each (total, 30 minutes) was applied with a latex tourniquet (remote ischemic conditioning). In group 3, this procedure was performed before flap elevation (remote ischemic preconditoning). In group 4, the procedure was performed 4 hours after flap ischemia (remote ischemic postconditioning). In group 5, the procedure was performed after the flap was elevated, during the muscle flap ischemia episode (remote ischemic perconditioning). Results The histopathological damage score in all remote conditioning ischemia groups was lower than in the ischemic-reperfusion group. The lowest histopathological damage score was observed in group 5 (remote ischemic perconditioning). Conclusions The nitric oxide levels were higher in the blood samples obtained from the remote ischemic perconditioning group. This study showed the effectiveness of remote ischemic conditioning procedures and compared their usefulness for preventing ischemiareperfusion injury in muscle flaps.
Keywords
Ischemic preconditioning; Reperfusion injury; Ischemia;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Kuntscher MV, Kastell T, Engel H, et al. Late remote ischemic preconditioning in rat muscle and adipocutaneous flap models. Ann Plast Surg 2003;51:84-90.   DOI
2 Labbe R, Lindsay T, Walker PM. The extent and distribution of skeletal muscle necrosis after graded periods of complete ischemia. J Vasc Surg 1987;6:152-7.   DOI
3 Mills SE. Histology for pathologists. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
4 Kuntscher MV, Juran S, Altmann J, et al. 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.   DOI
5 Nahabedian MY, Momen B, Manson PN. Factors associated with anastomotic failure after microvascular reconstruction of the breast. Plast Reconstr Surg 2004;114:74-82.
6 Moran SL, Serletti JM. Outcome comparison between free and pedicled TRAM flap breast reconstruction in the obese patient. Plast Reconstr Surg 2001;108:1954-60.   DOI
7 Loerakker S, Oomens CW, Manders E, et al. Ischemia-reperfusion injury in rat skeletal muscle assessed with T2-weighted and dynamic contrast-enhanced MRI. Magn Reson Med 2011;66:528-37.   DOI
8 Dillon JP, Laing AJ, Cahill RA, et al. Activated protein C attenuates acute ischaemia reperfusion injury in skeletal muscle. J Orthop Res 2005;23:1454-9.   DOI
9 Zheng J, Wang R, Zambraski E, et al. Protective roles of adenosine A1, A2A, and A3 receptors in skeletal muscle ischemia and reperfusion injury. Am J Physiol Heart Circ Physiol 2007;293:H3685-91.   DOI
10 Arato E, Kurthy M, Sinay L, et al. Effect of vitamin E on reperfusion injuries during reconstructive vascular operations on lower limbs. Clin Hemorheol Microcirc 2010;44:125-36.
11 Tatlidede SH, Murphy AD, McCormack MC, et al. Improved survival of murine island skin flaps by prevention of reperfusion injury. Plast Reconstr Surg 2009;123:1431-9.   DOI
12 Andreka G, Vertesaljai M, Szantho G, et al. Remote ischaemic postconditioning protects the heart during acute myocardial infarction in pigs. Heart 2007;93:749-52.   DOI
13 Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986;74:1124-36.   DOI
14 Koti RS, Seifalian AM, McBride AG, et al. The relationship of hepatic tissue oxygenation with nitric oxide metabolism in ischemic preconditioning of the liver. Faseb j 2002;16: 1654-6.   DOI
15 Dautel G, Braga da Silva J, Merle M. Pedicled or free flap transfer of the gracilis muscle in rats. J Reconstr Microsurg 1991;7:23-5.   DOI
16 Lorenzo AR, Lin CH, Lin CH, et al. Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers. J Plast Reconstr Aesthet Surg 2011;64:649-55.   DOI
17 Kuntscher MV, Schirmbeck EU, Menke H, et al. Ischemic preconditioning by brief extremity ischemia before flap ischemia in a rat model. Plast Reconstr Surg 2002;109: 2398-404.   DOI
18 Kuntscher MV, Kastell T, Sauerbier M, et al. Acute remote ischemic preconditioning on a rat cremasteric muscle flap model. Microsurgery 2002;22:221-6.   DOI
19 Addison PD, Neligan PC, Ashrafpour H, et al. Noninvasive remote ischemic preconditioning for global protection of skeletal muscle against infarction. Am J Physiol Heart Circ Physiol 2003;285:H1435-43.   DOI
20 Schmidt MR, Smerup M, Konstantinov IE, et al. Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATP-dependent mechanism: first demonstration of remote ischemic perconditioning. Am J Physiol Heart Circ Physiol 2007;292: H1883-90.   DOI
21 Kuntscher MV, Hartmann B, Germann G. Remote ischemic preconditioning of flaps: a review. Microsurgery 2005;25: 346-52.   DOI
22 Wang WZ, Anderson GL, Guo SZ, et al. Initiation of microvascular protection by nitric oxide in late preconditioning. J Reconstr Microsurg 2000;16:621-8.   DOI
23 Kuntscher MV, Kastell T, Altmann J, et al. Acute remote ischemic preconditioning II: the role of nitric oxide. Microsurgery 2002;22:227-31.   DOI
24 Peralta C, Closa D, Hotter G, et al. Liver ischemic preconditioning is mediated by the inhibitory action of nitric oxide on endothelin. Biochem Biophys Res Commun 1996;229: 264-70.   DOI