Acute Remote Preconditioning Augments Random Skin Flap Survival, But Not Recipient-Bed Isolated Flaps In Rats

This study proposes that acute remote preconditioning (ARIP) can effectively enhance random skin flap survival.The study was a randomized controlled trial using male sprague-Dawley rats as subjects. For acute remote preconditioning, left hindlimb ischemia was achieved by clamping the femoral artery and vein.After 1 hour's ischemia, the limb reperfusion was done for 30 minutes. Then, a 3by 9cm dorsal caudal-based, random pattern skin flap was elevated and reaproximated for flap survival studies. Thirty rats were divided into three groups of 10 rats each. The first group had only the flap raised, while the second and third groups had acute remote preconditioning protocol before the flap elevation. In the third group, a silicone sheet was inserted beneath the flap in order to prevent neovascularisation from the bed. The amount of flap necrosis was measured on the seventh postoperative day. ARIP (acute remote ischemic preconditioning) group had the most improved skin flap survival rate, and the flap survival rates between the ARIP+silicone sheet and control groups was not statistically different (p>0.05). These findings indicate that remote ischemic precontioning enhances random skin flap survival, when it is performed just before the flap harvest and the isolation of recipient bed abolishes this ameloriating effect.