Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study

Objectives: Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap.Methods: The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre+post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded.Results: The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p=0.01 and p=0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre+post-con group on Day 7 (p=0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre+post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap.Conclusion: The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.