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133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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

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  • Jonas Kolbenschlag - Martin-Luther Krankenhaus, Klinik für Plastische, Rekonstruktive, Ästhetische, Onkologische und Handchirurgie, Berlin, Deutschland
  • Alexander Sogorski - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Nicolai Kapalschinski - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Kamran Harati - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Marcus Lehnhardt - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Adrien Daigeler - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Tobias Hirsch - Bergmannsheil Bochum, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Ole Goertz - Martin-Luther Krankenhaus, Klinik für Plastische, Rekonstruktive, Ästhetische, Onkologische und Handchirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch408

doi: 10.3205/16dgch408, urn:nbn:de:0183-16dgch4084

Published: April 21, 2016

© 2016 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

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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.

Materials and 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<0.05 respectively). In free flaps, StO2 improved significantly on POD 1 and 12 as well as BF on PODs 5 and 12 (p<0.05). In pedicled flaps, BF and StO2 increases on POD12, but not significantly.

Conclusion: RIC is a safe, cheap, fast and reliable method to improve the microcirculation of surgical flaps. Further research is warranted to see if such an improvement translates to an improved flap survival, but it is likely.