Remote Ischemic Conditioning improves blood flow and oxygen saturation in pedicled and free surgical flaps.

Background: Surgical flaps have become safe and reliable tools in the reconstructive armamentarium. However, total flap loss rates of up to 25% and partial flap loss rates up to 36% are reported in the literature, most often due to insufficient perfusion and the resulting hypoxia. Therefore, a reliable, non-invasive and effective way to improve the microcirculation of surgical flaps is desirable. Remote Ischemic Conditioning (RIC) is the repeated application of non-damaging cycles of ischemia and reperfusion on an organ remote to the tissue to be conditioned. It is known to improve microcirculation and attenuate ischemia / reperfusion injury (IRI) and has seen growing application in various fields. While there are promising findings on the effect of RIC on surgical flaps in animal models, no such application in humans has been reported yet. Therefore, the aim of this study was to assess the effect of RIC on the microcirculation of pedicled and free surgical flaps. Methods: Thirty patients undergoing free (n=20) and pedicled (n=10) tissue transfer were included in this study. RIC was applied on the upper extremity for three cycles on postoperative days (POD) 1, 5 and 12. Blood flow (BF), tissue oxygen saturation (StO2) and relative hemoglobin content (rHb) were measured via a combination of laser Doppler and spectroscopy (O2C device) in the flap and the surrounding tissue. The relative increase compared to baseline measurements was assessed. Results: BF increased significantly in controls on all three PODs (p

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