gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Upper extremity ischemia is superior to lower extremity ischemia for remote ischemic conditioning of antero-lateral thigh cutaneous blood flow

Meeting Abstract

  • Jonas Kolbenschlag - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Alexander Sogorski - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Kamran Harati - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Adrien Daigeler - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Albrecht Wiebalck - Ruhrland Klinik, Abteilung für Anästhesie und Schmerzmedizin, Essen, Deutschland
  • Nicolai Kapalschinski - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Marcus Lehnhardt - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Ole Goertz - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch561

doi: 10.3205/15dgch561, urn:nbn:de:0183-15dgch5610

Published: April 24, 2015

© 2015 Kolbenschlag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Remote ischemic conditioning (RIC) is known to improve microcirculation in various settings, but little is known about the impact of the amount of ischemic tissue mass or the limb itself. Since ischemia and subsequent necrosis of flaps is one of the most dreaded complications in reconstructive surgery, adjuvant methods to improve microcirculation are desirable. We therefore performed a randomized trial to compare the effect of arm vs. leg ischemia for RIC of the cutaneous microcirculation of the antero-lateral thigh.

Material and methods: 40 healthy volunteers were randomized to undergo five minutes of ischemia of either the upper or lower extremity, followed by ten minutes of reperfusion.

Ischemia was induced by a surgical tourniquet applied to the proximal limb, which was inflated to 250mmHg for the upper and 300mgHg for the lower extremity.

This cycle was repeated a total of three times. Cutaneous microcirculation was assessed by combined laser doppler spectrophotometry on the antero-lateral aspect of the thigh to measure cutaneous blood flow (BF), relative hemoglobin content (rHb) and oxygen saturation (StO2). Baseline measurements were performed for 10 minutes, after which the ischemia / reperfusion cycles were begun. Measurements were performed continuously and were afterwards pooled to obtain a mean value per minute.

Results: Both groups showed significant increases in all three measured parameters of cutaneous microcirculation after three cycles of ischemia / reperfusion when compared to baseline (BF: 95.1% (p < 0.001) and 27.9% (p=0.002); rHb: 9.4% (p < 0.001) and 5.9% (p < 0.001), StO2: 8.4% (p= 0.045) and 9.4% (p < 0.001). When comparing both groups, BF was significantly higher in the arm group (p=0.019 after 11 min., p = 0.009 after 45 min).

Conclusion: Both ischemic conditioning of the upper and lower extremity is able to improve cutaneous blood flow on the ALT donor site. However, remote ischemic conditioning of the upper extremity seems to be a superior trigger for improvement of cutaneous blood flow.