Abstract
Ischemic preconditioning (IP) of a flap is defined as a brief period of ischemia (“preclamping”) followed by tissue reperfusion that increases the tolerance of the flap for a subsequent longer ischemic period. Several studies have showed the effectiveness of classic local IP by preclamping the flap pedicle.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Ciaschini M, Bernard SL. History of plastic surgery. http://www.emedicine.com/plastic/topic433.htm. Accessed March 2001.
McCarthy JG. Introduction. In: McCarthy JG, editor. Plastic Surgery. Philadelphia: WB Saunders, 1990.
Nichter LS, Morgan RF, Nichter MA. The impact of Indian methods for total nasal reconstruction. Clin Plast Surg. 1983;10(4):635–647.
Lascaratos J, Cohen M, Voros D. Plastic surgery of the face in Byzantium in the fourth century. Plast Reconstr Surg. 1998;102(4):1274–1280.
Bennett JP. Aspects of the history of plastic surgery since the 16th century. J R Soc Med. 1983;76(2):152–156.
Micali G. The Italian contribution to plastic surgery. Ann Plast Surg. 1993;31(6):566–571.
Mahon-Deri B, O’Leary JP. The birth of modern “plastik” plastic surgery. Am Surg. 1994;60(9):719–720.
McDowell F. Plastic surgery in the twentieth century. Ann Plast Surg. 1978;1(2):217–224.
Stark RB. The history of plastic surgery in wartime. Clin Plast Surg. 1975;2(4):509–516.
Tamai S. History of microsurgery—from the beginning until the end of the 1970’s. Microsurgery. 1993;14:6–13.
Olivari N. The latissimus dorsi flap. Br J Plast Surg. 1976;29:126–128.
Holmström H. The free abdominoplasty and its use in breast reconstruction. Scand J Plast Reconstr Surg. 1979;13:423.
Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32:32–38.
Allen RJ, Tucker C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg. 1995;95:1207–1212.
Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995;96:1608–1614.
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42:645–648.
Wei FC, Jain V, Suominen S, Chen HC. Confusion among perforator flaps: what is a true perforator flap? Plast Reconstr Surg. 2001;107:874–876.
Massberg S, Messmer K. The nature of ischemia/reperfusion injury. Transpl Proc. 1998;30:4217–4223.
Messmer K, Sack FU, Menger MD, et al. White cell-endothelium interaction during postischemic reperfusion of skin and skeletal muscle. Adv Exp Med Biol. 1988;242:95.
Harlan JM, Killen PD, Harker LA, Striker GE. Neutrophil-mediated endothelial injury in vitro. J Clin Invest. 1981;68:1394–1403.
Sacks T, Moldow CF, Craddock PR, Bowers TK, Jacobs HS. Oxygen radicals mediate endothelial cell damage by complement-stimulated granulocytes. J Clin Invest. 1978;61:1161–1167.
Siemionow M, Wang WZ, Anderson G, Firrell J. Leukocyte-endothelial interaction and capillary perfusion in ischemnia-reperfusion of the rat cremaster muscle microcirculation, endothelium and lymphatics. 1991;7(4–6):183–197.
May JW, Chait LA, O’Brien JV, Hurley JV. The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg. 1978;61:256–267.
Stotland MA, Kerrigan CL. E-and L-selectin adhesion molecules in musculocutaneous flap reperfusion injury. Plast Reconstr Surg. 1997;99(7):2010–2020.
Hammerman C, Kaplan M. Ischemia and reperfusion injury. The ultimate pathophysiologic paradox. Clin Perinatol. 1998;25:757–777.
Restifo RJ, Ahmed SS, Isenberg JS, Thomson JG. Timing, magnitude, and utility of surgical delay in the TRAM flap, I: animal studies. Plast Reconstr Surg. 1997;99:1211–1216.
Restifo RJ, Ahmed SS, Isenberg JS, Thomson JG. Timing, magnitude, and utility of surgical delay in the TRAM flap, II: clinical studies. Plast Reconstr Surg. 1997;99:1217–1223.
Restifo RJ, Thomson JG. The preconditioned TRAM flap: preliminary clinical experience. Ann Plast Sur. 1998;41(4):343–347.
Taylor GI, Corlett RJ, Caddy CM, Zelt RG. An anatomic review of the delay phenomenon: II Clinical applications. Plast Reconstr Surg. 1992;89:408.
Codner MA, Bostwick J III, Nahai F, Bried JT, Eaves FF. TRAM flap vascular delay for high-risk breast reconstruction. Plast Reconstr Surg. 1995;96(7):1615–1622.
Erdmann D, Sundin BM, Moquin KJ, Young H, Georgiade GS. Delay in unipedicle TRAM flap reconstruction of the breast: a review of 76 consecutive cases. Plast Reconstr Surg. 2002;110(3):762–767.
Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg. 1981;67:177–187.
Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986;74(5):1124–1136.
Lloris-Carsi JM, Cejalvo D, Toledo-Pereyra LH, Calvo MA, Suzuki S. Preconditioning: effect upon lesion modulation in warm liver ischemia. Transplant Proc. 1993;25(6):3303–3304.
Islam CF, Mathie RT, Dinneen MD, Kiely EA, Peters AM, Grace PA. Ischemia-reperfusion injury in rat kidney: the effect of preconditioning. Br J Urol. 1997;79:842–847.
Carroll CM, Carroll SM, Overgoor ML, Tobin G, Barker JH. Acute ischemic preconditioning of skeletal muscle prior to flap elevation augments muscle flap survival. Plast Reconstr Surg. 1997;100(1):58–65.
Mounsey RA, Pang CY, Forrest C. Preconditioning: a new technique for improved muscle flap survival. Otolaryngol Head Neck Surg. 1992;107(4):549–552.
Wang WZ, Anderson G, Firrell JC, Tsai TM. Ischemic preconditioning versus intermittent reperfusion to improve blood flow to a vascular isolated skeletal muscle flap of rats. J Trauma. 1998;45(5):953–959.
Adanali G, Ozer K, Siemionow M. Early and late effects of ischemia preconditioning on microcirculation of skeletal muscle flaps. J Plast Reconstr Surg. 2002;109(4):1344–1351.
Zahir KS, Syed SA, Zink JR, Restifo RJ, Thomson JG. Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model. Plast Reconstr Surg. 1998;102(1):140–50; discussion:151–152.
Giunta R, Geisweid A, Feller AM. Clinical classification of free-flap perfusion complications. J Reconstr Microsurg. 2001;17(5):341–345.
Przyklenk K, Bauer B, Ovize M, Kloner RA, Whittaker P. Regional ischemic “preconditioning” protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation. 1993;87(3):893–899.
Verdouw PD, Gho BC, Koning MM, Schoemaker RG, Duncker DJ. Cardioprotection by ischemic and nonischemic myocardial stress and ischemia in remote organs. Implications for the concept of ischemic preconditioning. Ann N Y Acad Sci. 1996;30;793:27–42.
Birnbaum Y, Hale SL, Kloner RA. Ischemic preconditioning at a distance: reduction of myocardial infarct size by partial reduction of blood supply combined with rapid stimulation of the gastrocnemius muscle in the rabbit. Circulation. 1997;96(5):1641–1646.
Oxman T, Arad M, Klein R, Avazov N, Rabinowitz B. Limb ischemia preconditions the heart against reperfusion tachyarrhythmia. Am J Physiol. 1997;273(4 Pt 2):H1707–1712.
Küntscher MV, Schirmbeck EU, Menke H, Klar E, Gebhard MM, Germann G. Ischemic preconditioning by brief extremity ischemia before flap ischemia in a rat model. Plast Reconstr Surg. 2002;109(7):2398–2404.
Küntscher MV, Kastell T, Sauerbier M, Nobiling R, Gebhard MM, Germann G. Acute remote ischemic preconditioning on a rat cremasteric muscle flap model. Microsurgery. 202;22(6):221–226.
Wei FC, Chang YC, Lee YH, Wang KC, Lee J. Comparison of skeletal muscle microcirculation between clamp ischemia and microsurgical ischemia. Microsurgery. 1996;17(3):123–127.
Addison PD, Neligan PC, Ashrafpour H, Khan A, Zhong A, Moses M, et al. Noninvasive remote ischemic preconditioning for global protection of skeletal muscle against infarction. Am J Physiol Heart Circ Physiol. 2003;285(4):H1435–1443.
Küntscher MV, Kastell T, Engel H, Gebhard MM, Heitmann C, Germann G. Late remote ischemic preconditioning in rat muscle and adipocutaneous flap models. Ann Plast Surg. 2003;51(1):84–90.
Takaoka A, Nakae I, Mitsunami K, et al. Renal ischemia/reperfusion remotely improves myocardial energy metabolism during myocardial ischemia via adenosine receptors in rabbits: effects of “remote preconditioning” J Am Coll Cardiol. 1999;33(2):556–64.
Dickson EW, Lorbar M, Porcaro WA, et al. Rabbit heart can be “preconditioned” via transfer of coronary effluent. Am J Physiol. 1999;277(6 Pt 2):H2451–2457.
Schoemaker RG, van Heijningen CL. Bradykinin mediates cardiac preconditioning at a distance. Am J Physiol Heart Circ Physiol. 2000;278(5):H1571–1576.
Dawn B, Bolli R. Toward a better understanding of the metabolic effects of ischemic preconditioning in humans. J Cardiothorac Vasc Anesth. 2001;15(4):409–411.
Nandagopal K, Dawson TM, Dawson VL. Critical role for nitric oxide signaling in cardiac and neuronal ischemic preconditioning and tolerance. J Pharmacol Exp Ther. 2001;297(2):474–478.
Peralta C, Hotter G, Closa D, Gelpí E, Bulbena O, Roselló-Catafau J. Protective effect of preconditioning on the injury associated to hepatic ischemia-reperfusion in the rat: role of nitric oxide and adenosine. Hepatology. 1997;25:934–937.
Kume M, Yamamoto Y, Saad S, et al. Ischemic preconditioning of the liver in rats: Implications of heat shock protein induction to increase tolerance of ischemia-reperfusion injury. J Lab Clin Med. 1996;128:251–258.
Lille S, Su CY, Schoeller T, et al. Induction of heat-shock protein 72 in rat skeletal muscle does not increase tolerance to ischemia-reperfusion injury. Muscle Nerve. 1999;22:390–393.
Wang BH, Ye C, Stagg CA, et al. Improved free musculocutaneous flap survival with induction of heat shock protein. Plast Reconstr Surg. 1998;101(3):776–784.
Pang CY, Neligan P, Zhong A, He W, Xu H, Forrest CR. Effector mechanism of adenosine in acute ischemic preconditioning of skeletal muscle against infarction. Am J Physiol. 1997;273:R887–895.
Yokota R, Fujiwara H, Miyamae M, et al. Transient adenosine infusion before ischemia and reperfusion protects against metabolic damage in pig hearts. Am J Physiol. 1995;268:H1149–1157.
Pang CY, Neligan P, Xu H, et al. Role of ATP-sensitive K+ channels in ischemic preconditioning of skeletal muscle against infarction. Am J Physiol. 1997;273:H44–51.
Guo Y, Bao W, Wu WJ, Shinmura K, Tang XL, Bolli R. Evidence for an essential role of cyclooxygenase-2 as a mediator of the late phase of ischemic preconditioning in mice. Basic Res Cardiol. 2000;95(6):479–484.
Peralta C, Closa D, Hotter G, Gelpí E, Prats N, Roselló-Catafau J. Liver ischemic preconditioning is mediated by the inhibitory action of nitric oxide on endothelin. Biochem Biophys Res Comm. 1996;229:271–274.
Küntscher MV, Juran S, Altmann J, Menke H, Gebhard MM, Germann G. The role of nitric oxide in the mechanism of preclamping and remote ischemic preconditioning of flaps in a rat model. J Reconstr Microsurg. 2003;19(1):55–60.
Küntscher MV, Kastell T, Altmann J, Menke H, Gebhard MM, Germann G. Acute remote ischemic preconditioning II: the role of nitric oxide. Microsurgery. 2002;22(6):227–231.
Chen JX, Berry LC, Tanner M, Chang M, Myers RP, Meyrick B. Nitric oxide donors regulate nitric oxide synthase in bovine pulmonary artery endothelium. J Cell Physiol. 2001;186(1):116–123.
Rakhit RD, Edwards RJ, Marber MS. Nitric oxide, nitrates and ischaemic preconditioning. Cardiovasc Res. 1999;43(3):621–627.
Cordeiro PG, Santamaria E, Hu QY. Use of a nitric oxide precursor to protect pig myocutaneous flaps from ischemia-reperfusion injury. Plast Reconstr Surg. 1998;102:2040–2048; discussion, 2049–2051.
Küntscher MV, Juran S, Menke H, Gebhard MM, Erdmann D, Germann G. The role of pre-ischaemic application of the nitric oxide donor spermine/nitric oxide complex in enhancing flap survival in a rat model. Br J Plast Surg. 2002;55(5):430–433.
Ghaleh B, Tissier R, Berdeaux A. Nitric oxide and myocardial ischemic preconditioning. J Soc Biol. 2000;194(3–4):137–141.
Jones WK, Flaherty MP, Tang XL, Takano H, Qiu Y, Banerjee S, et al. Ischemic preconditioning increases iNOS transcript levels in conscious rabbits via a nitric oxide-dependent mechanism. J Mol Cell Cardiol. 1999;31(8):1469–1481.
Wang WZ, Anderson GL, Guo SZ, Tsai TM, Miller FN. Initiation of microvascular protection by nitric oxide in late preconditioning. J Reconstr Microsurg. 2000;16(8):621–628.
Oshima H. The influence of skin flap ischemia on serum nitric oxide concentrations. Microsurgery. 1996;17(4):191–197.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer-Verlag London Limited
About this chapter
Cite this chapter
Küntscher, M.V., Hartmann, B., Germann, G. (2006). Remote Ischemic Preconditioning of Flaps: Current Concepts. In: Siemionow, M.Z. (eds) Tissue Surgery. New Techniques in Surgery Series, vol 1. Springer, London. https://doi.org/10.1007/1-84628-128-8_8
Download citation
DOI: https://doi.org/10.1007/1-84628-128-8_8
Publisher Name: Springer, London
Print ISBN: 978-1-85233-970-8
Online ISBN: 978-1-84628-128-0
eBook Packages: MedicineMedicine (R0)