title: Bilirubin provides perforator flap protection from ischaemia-reperfusion injury in a rat model: a preliminary result.
abstract: The use of bilirubin, a well-known and powerful antioxidant, has gained popularity in recent years because of its role in the prevention of ischaemic heart disease in patients with Gilbert's syndrome. We investigate the effects of bilirubin on ischaemia-reperfusion (I/R) injury using a rat perforator flap model. Forty-eight rats were randomly divided into two groups: experimental (bilirubin) group (n = 24) and control group (n = 24). In each group, elevated bilateral deep inferior epigastric perforator (DIEP) flaps were created. The right (no ischaemia side) and left (ischaemia side) DIEP flaps were separated according to the presence of ischaemia induction. Ischaemia was induced in anaesthetised rats by perforator clamping for 15 or 30 minutes. After surgery, the flap survival was assessed daily on postoperative days 0 to 5, and overall histological changes of DIEP flaps above the perforator were analysed at postoperative day 5. The flap survival rate in the bilirubin group was significantly higher than that in the control group at the ischaemia side following perforator clamping for 15 or 30 minutes (93·42 ± 4·48% versus 89·63 ± 3·98%, P = 0·002; and 83·96 ± 4·23% versus 36·46 ± 6·38%, P < 0·001, respectively). The difference in flap survival between the two groups was the most prominent on the ischaemic side following 30 minutes of perforator clamping. From a morphologic perspective, pre-treatment with bilirubin was found to alleviate perforator flap necrosis caused by I/R injury in this experimental rat model.
authors.affiliation: Department of Biochemistry, College of Medicine, Konkuk University, Seoul, South Korea.
authors.forename: Sung Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, College of Medicine, Yonsei University, Seoul, South Korea.
authors.forename: Dong Kyun
authors.initials: DK
authors.lastname: Rah
authors.affiliation: Department of Pathology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, South Korea.
authors.forename: Yosep
authors.initials: Y
authors.lastname: Chong
authors.affiliation: Department of Biochemistry, College of Medicine, Konkuk University, Seoul, South Korea.
authors.forename: Song Hyun
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, College of Medicine, Yonsei University, Seoul, South Korea. hard-piano@hanmail.net.
authors.forename: Tae Hwan
authors.initials: TH
authors.lastname: Park
mesh_terms: D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use*; D001663:Bilirubin / Q000627:therapeutic use*; D004195:Disease Models, Animal; D008297:Male; D061525:Perforator Flap / Q000009:adverse effects* / Q000098:blood supply*; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000975:Antioxidants; D001663:Bilirubin
keywords: Bilirubin; Ischaemia; Perforator flap; Reperfusion