, Volume 7, Issue 3, pp 297–302 | Cite as

Expression of inducible nitric oxide synthase in muscle flaps treated with ischemic postconditioning

  • Mei Yang
  • Michael F. Angel
  • Yi Pang
  • John J. Angel
  • Zhe Wang
  • Michael W. Neumeister
  • Nathan Wetter
  • Feng ZhangEmail author
Therapy Articles



Preconditioning has been considered promising for the treatment of ischemic flaps. In this study, the therapeutic effect of postconditioning was compared with that of preconditioning during ischemia/reperfusion (I/R) injury, and a role of inducible nitric oxide synthase (iNOS) in postconditioning treatment was also explored.


Sixty rats were randomly divided into four groups with 15 rats in each group. Ischemic injury was induced in a rat’s gracilis muscle flap model. Preconditioning and postconditioning were performed respectively on the flaps in the pre-con group and the post-con group. No treatment was given to the flaps in the control group, and flaps without I/R injury were used as a sham control. Muscle viability ratio, histology, and gene expression of iNOS were examined at different time intervals (3, 12, and 18 h).


A significantly higher survival ratio was observed in both the pre-con group (78.98 ± 3.39, 62.74 ± 3.7, and 54.42 ± 4.45 %) and the post-con group (77.42 ± 4.14, 59.74 ± 6.67, and 49.52 ± 4.13 %) than the control group (45.22 ± 3.69, 42.44 ± 3.76, and 33.2 ± 3.29 %) at 3, 12, and 18 h postoperatively (P < 0.05). There was no statistical difference between the pre-con group and the post-con group (P > 0.05). Histological examination showed delayed and attenuated tissue damage in both the pre-con group and the post-con group when compared to that of the control group. A higher expression of iNOS was observed in both the pre-con group and the post-con group than the control group and the sham group (P < 0.05).


Significant improvement of flap survival could be achieved by both preconditioning and postconditioning treatments; however, better protection could be provided by preconditioning. The higher expression of iNOS may play an important role in the therapeutic effect of postconditioning during I/R injury.


Ischemic postconditioning Ischemic preconditioning Ischemia/reperfusion (I/R) injury Inducible nitric oxide synthase 



The authors thank Professor Zhengwei Cai for his guidance in the process of this experimental study.

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© American Association for Hand Surgery 2012

Authors and Affiliations

  • Mei Yang
    • 1
  • Michael F. Angel
    • 2
  • Yi Pang
    • 2
  • John J. Angel
    • 2
  • Zhe Wang
    • 2
  • Michael W. Neumeister
    • 1
  • Nathan Wetter
    • 1
  • Feng Zhang
    • 2
    Email author
  1. 1.Division of Plastic SurgerySouthern Illinois University School of MedicineSpringfieldUSA
  2. 2.Division of Plastic Surgery, Department of SurgeryUniversity of Mississippi Medical CenterJacksonUSA

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