title: Remote Ischemic Conditioning Improves Blood Flow and Oxygen Saturation in Pedicled and Free Surgical Flaps.
abstract: BACKGROUND
  Surgical flaps have become safe and reliable reconstructive tools, but total flap loss rates as high as 25 percent and partial flap loss rates as high as 36 percent have been reported due to insufficient perfusion. Therefore, a reliable, noninvasive, and effective way to improve the microcirculation of surgical flaps is desirable. The aim of this study was to assess the effect of remote ischemic conditioning on the microcirculation of pedicled and free surgical flaps.
  
  
  METHODS
  Thirty patients undergoing free (n = 20) and pedicled (n = 10) tissue transfer were included in this study. Remote ischemic conditioning was applied on the upper extremity for three cycles on postoperative days 1, 5, and 12. Blood flow, tissue oxygen saturation, and relative hemoglobin content were measured by means of a combination of laser Doppler and spectroscopy (O2C device) in the flap and the surrounding tissue. The relative increase compared with baseline measurements was assessed.
  
  
  RESULTS
  Blood flow increased significantly in controls on all 3 postoperative days (p < 0.05 for all). In free flaps, tissue oxygen saturation improved significantly on postoperative days 1 and 12 and blood flow improved significantly on postoperative days 5 and 12 (p < 0.05). In pedicled flaps, blood flow and tissue oxygen saturation increased on postoperative day12, but not significantly.
  
  
  CONCLUSIONS
  Remote ischemic conditioning is a safe, inexpensive, fast, and reliable method to improve the microcirculation of surgical flaps. Further research is warranted to see whether such an improvement translates into improved flap survival, but it is likely.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Jonas
authors.initials: J
authors.lastname: Kolbenschlag
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sogorski
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Kapalschinski
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Kamran
authors.initials: K
authors.lastname: Harati
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Adrien
authors.initials: A
authors.lastname: Daigeler
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hirsch
authors.affiliation: Bochum and Berlin, Germany.|From the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Burn Center, Ruhr University Bochum; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Hand Surgery, Martin-Luther-Hospital Berlin.
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001783:Blood Flow Velocity; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000378:metabolism; D011182:Postoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010100:Oxygen