Summary
Objective
Free flap transfer is a safe and reliable technique for soft tissue reconstruction.
However, impaired flap perfusion with consecutive microcirculatory failure leading
to partial or total flap failure remains a clinically relevant problem.
Remote ischemic conditioning (RIC) has been shown to improve microcirculation in adipo-cutaneous
tissues in healthy humans as well as in free flaps. Yet, little is known about its
effects on different perfusion zones in free flaps and the duration of these effects.
Methods
Twenty-five patients with free perforator-based adipo-cutaneous flap transfer were
included in the study. RIC (3 cycles: 10/10 min ischemia/reperfusion) was applied
via an inflatable tourniquet placed on the upper arm. Continuous measurement of flaps’
microcirculation on postoperative day (POD) 1, 3, and 5 was performed by utilizing
an O2C device (“Oxygen-to-see” ©LEA Medizintechnik Germany) during RIC and for the
following 4 h. Probes were located both in the flaps’ center and on its distal edge.
Results
Twenty patients were included in the final analysis. RIC significantly improved flaps’
blood flow (BF) by a max. of + 19.6% and oxygen saturation of + 15.7%. Changes affected
the entire flap, without significant difference between zones. The increase in flap
perfusion could be observed for at least 4 h after the completion of RIC.
Conclusion
Postoperative application of RIC might serve as an additional treatment to enhance
whole flap perfusion and prevent microcirculatory disorders, therefore reducing the
risk for potential tissue necrosis, especially in the distal parts of the flaps.
Keywords
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Article info
Publication history
Published online: August 28, 2022
Accepted:
August 17,
2022
Received:
June 29,
2021
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
