In this study a comparison was made to the efficacy of three cycles of various duration of ischemic preconditioning (IPC) on flap survival after the critical ischemic time. Method: In the first study, 20 Sprague-Dawley rats were used (6 groups of rats; flap ischemia ranging from 6 to 14 h) to determine the critical ischemia time for the rat groin flap (6×3 cm). In the second study the rats (n=31 were divided into nine groups; ischemia and reperfusion times being 5, 10 or 15 min) a groin flap was elevated. Thereafter IPC was induced to the flap by clamping its pedicle prior to the critical ischemic time (14 h). Three cycles of IPC were applied. After seven days, the flap was retraced for viability assessment and the surviving flap area was calculated with planimetry. Results: Without pretreatment with IPC flap survival after 8, 10, 12, 13, and 14 h global ischemia was respectively 100%, 77±13%, 78±15%, 42±16%, and 2±4%. When the flaps were treated with three cycles of IPC before 14 h global ischemia the significant flap survival was noted in the 10/5 min and 15/10 min IPC groups (p<0.05). Overall, the 5 min reperfusion groups increased flap survival (38±26%; p<0.05), and had fewer total flap losses (2/9) than the 10 or 15 min reperfusion groups. Only if ischemia time was longer than reperfusion time the flaps had increased survival area (40±22%, p<0.05). Conclusion: This study demonstrated the efficacy of IPC to improve the viability of a composite flap even after a long critical ischemic time. The optimal IPC duration was 10/5 min combination, yet the 15/10 schedule was also acceptable.
European Journal of Plastic Surgery – Springer Journals
Published: Feb 8, 1999
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