Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia‐reperfusion injury

Abstract

RIPER reduced IL-6 and IL-12p40 secretion during reperfusion of porcine musculocutaneous flaps, when compared with hypothermic ischemic flaps and normothermic ischemic flaps without RIPER. © 2016 Wiley Periodicals, Inc. Microsurgery 37:148-155, 2017.

Local and systemic coagulation marker response to musculocutaneous flap ischemia–reperfusion injury and remote ischemic conditioning: An experimental study in a porcine model

“…Four hours of ischemia was chosen to induce substantial flap ischemia–reperfusion injury without exceeding the critical ischemia time of musculocutaneous flaps and thereby risking microcirculatory failure. Our previous study confirmed that the flaps were exposed to ischemia–reperfusion injury shown by histological and immunological analyses (Krag et al, ). We administered RIC after onset of flap ischemia and before reperfusion, so‐called remote ischemic perconditioning (Schmidt et al, ) to study an isolated effect on coagulation after flap ischemia–reperfusion injury and to avoid a perconditioning effect on the flaps.…”

“…The systemic coagulation marker response to flap ischemia–reperfusion injury was investigated by comparing measurements obtained before flap reperfusion with 5 h of reperfusion, because flap inflammation peaked at 5 h of reperfusion in the same model (Krag et al, ). Musculocutaneous flap ischemia–reperfusion injury reduced thrombin generation lag time and time‐to‐peak thrombin indicating hypercoagulation, but it also reduced peak thrombin and ETP indicating hypocoagulation.…”

“…Sixteen female Danish Landrace pigs were included in the study (mean weight 39 kg, range 35–42 kg). Following the principles of replacement, reduction, and refinement for animal studies, we used pigs that were also part of a previously published study (Krag et al, ).…”

“…The animals were anesthetized and euthanized as previously described (Krag et al, ). After induction of general anesthesia, the large neck vessels were dissected on the left side.…”

“…This experimental treatment reduced infarct size after angioplasty in a randomized controlled trial on acute myocardial infarction (Botker et al, ). Furthermore, RIC reduced infarct size (Addison et al, ) and attenuated acute inflammation (Krag et al, ) in porcine latissimus dorsi flaps subjected to ischemia–reperfusion injury. The tissue‐protective mechanisms behind RIC are multifactorial with humoral and neural pathways being investigated (Addison et al, ).…”