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Use of mechanical preconditioning for free flaps in a swine model

  • Experimental Study
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Abstract

Background

Mechanical ischemic preconditioning (MIPC) is defined as applying brief periods of ischemia before tissue reperfusion. This mechanism protects tissues against injury from sustained ischemia followed by reperfusion. We aimed to analyze the effects of MIPC on the tolerance of muscle flap tissue depending on the type and duration of ex vivo cold ischemia storage.

Methods

We studied the effects of MIPC on interstitial edema, inflammation, and muscle necrosis. Thirty-two porcine latissimus dorsi flaps were equally divided over four groups. Groups were divided based on the application of MIPC (every 15 min for a total of 1 h) or not, and the submersion into heparin or IGL-1®. Iterative biopsies were performed before harvesting the flap and one, two and 3 h after cold ischemia storage.

Results

Preconditioning free flaps before cold storage in heparin significantly decreased muscle necrosis, interstitial edema, and muscle cell size. Respectively, a decrease of 67%, 37% and 28% was seen in this group (p < 0.05). Preconditioning free flaps before cold storage in IGL-1® reduced necrosis by 26%, interstitial edema by 37% and muscle cell size by 33% (p < 0.05).

Conclusions

We found that MIPC significantly reduces interstitial edema, inflammation and necrosis and may increase the rate of successful revascularizations. However, studies assessing those tissular damage parameters after reperfusion of the flap need to be performed to assess more correctly inflammation and post-operative infections and to confirm the potential benefits of ICP.

Level of evidence: Not gradable

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Author information

Authors and Affiliations

  1. Sorbonne University, Paris, France

    Sarra Cristofari, Alessio Stivala, Sara Leuzzi, Lorraine Litrico & Anne Janin

  2. Department of Plastic Surgery, AP-HP, Tenon Hospital, Paris, France

    Sarra Cristofari

  3. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

    Loïc Van Dieren

  4. Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 50 Blossom St, Boston, MA, 02114, USA

    Loïc Van Dieren,  Curtis L. Cetrulo & Alexandre G. Lellouch

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  1. Sarra Cristofari
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sarra Cristofari, Sara Leuzzi and Alessio Stivala. The first draft of the manuscript was written by Sarra Cristofari and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alexandre G. Lellouch.

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Ethics approval

This study was performed in line with the policies described in the Guide for the Care and Use of Laboratory Animals. Approval was granted by the Ethics Committee of the Sorbonne University (No. 16–001—APAFiS #9221).

Competing interests

Sarra Cristofari, Alessio Stivala, Sara Leuzzi, Loïc Van Dieren, Lorraine Litrico, Curtis L. Cetrulo Jr., Anne Janin, and Alexandre G. Lellouch declare no competing interests.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Cristofari, S., Stivala, A., Leuzzi, S. et al. Use of mechanical preconditioning for free flaps in a swine model. Eur J Plast Surg 46, 645–652 (2023). https://doi.org/10.1007/s00238-023-02096-8

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  • DOI: https://doi.org/10.1007/s00238-023-02096-8

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