Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap

Abstract

Abstract:Objective: Skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs in plastic surgery. The mechanisms of I/R injury include hypoxia, inflammation, and oxidative damage. Hydrogen gas has been reported to alleviate cerebral I/R injury by acting as a free radical scavenger. Here, we assessed the protective effect of hydrogen-rich saline (HRS) on skin flap I/R injury. Methods: Abdominal skin flaps of rats were elevated and ischemia was induced for 3 h; subsequently, HRS or physiological saline was administered intraperitoneally 10 min before reperfusion. On postoperative Day 5, flap survival, blood perfusion, the accumulation of reactive oxygen species (ROS), and levels of cytokines were evaluated. Histological examinations were performed to assess inflammatory cell infiltration. Results: Skin flap survival and blood flow perfusion were improved by HRS relative to the controls. The production of malondialdehyde (MDA), an indicator of lipid peroxidation, was markedly reduced. A multiplex cytokine assay revealed that HRS reduced the elevation in the levels of inflammatory cytokines, chemokines and growth factors, with the exception of RANTES (regulated on activation, normal T-cell expressed and secreted) growth factor. HRS treatment also reduced inflammatory cell infiltration induced by I/R injury. Conclusions: Our findings suggest that HRS mitigates I/R injury by decreasing inflammation and, therefore, has the potential for application as a therapy for improving skin flap survival.

Dietary Nitrate Protects Against Skin Flap Ischemia-Reperfusion Injury in Rats via Modulation of Antioxidative Action and Reduction of Inflammatory Responses

“…After reperfusion, inflammatory cell infiltration in injured tissues is responsible for the production of inflammatory factors, including TNF-a and IL-6, which subsequently trigger a feedback loop in inflammatory cascades, leading to tissue dysfunction and damage (Aboutaleb et al, 2019). Moreover, inflammatory cytokines can further activate the immune/ inflammatory response and result in the extension of injury (Zhao et al, 2013). Consequently, cellular apoptosis and tissue necrosis are induced.…”

Necrostatin-1 protects against ischemia/reperfusion injury by inhibiting receptor-interacting protein 1 in a rat flap model

“…Even in cases of microsurgical transfer by experienced hands in the presence of a stable blood supply, skin flap loss still ranges from 1% to 5%. 13,14 There are many reasons for partial or total flap loss, including I/R injury. I/R injury is tissue damage caused by the blood supply returning to the tissue after a period of ischemia; cell death is the worst consequence of ischemia.…”

“…This study reveals Nec-1 may have therapeutic potential to prevent and treat I/R injury in flap transplantation. 13 By using Nec-1, we might partly protect flaps from I/R injury after surgery. Especially in patients with a high risk of flap complications (diabetes, malnutrition, and infection).…”

“…In addition to Nec-1, many other drugs have been discovered that have therapeutic effects against I/R injury, such as hydrogen-rich saline, 11,13 methane-rich saline, 27 hydroxyzine, and cimetidine. 28 However, all these drugs focus on classic cell death pathways, such as apoptosis and necrosis.…”

Luminal Injection of Hydrogen-Rich Solution Attenuates Intestinal Ischemia-Reperfusion Injury in Rats

“…18 In addition, hydroxyl radicals are mainly released at early phase after reperfusion. Zao et al 21 reported the protective effect of hydrogen-rich solution on the abdominal skin flap after ischemia reperfusion by intraperitoneal administration. Chuai et al 20 showed the reduction rate of hydroxyl radicals had strong correlation with hydrogen concentration.…”