Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Effects of Ischemic Preconditioning of Different Intraoperative Ischemic Times of Vascularized Bone Graft Rabbit Models

  • Received : 2013.06.03
  • Accepted : 2013.08.07
  • Published : 2013.11.15
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Abstract

Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18- hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.

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References

  1. Shadgan B, Menon M, O'Brien PJ, et al. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 2008;22:581-7. https://doi.org/10.1097/BOT.0b013e318183136d
  2. Berenshtein E, Vaisman B, Goldberg-Langerman C, et al. Roles of ferritin and iron in ischemic preconditioning of the heart. Mol Cell Biochem 2002;234-235:283-92. https://doi.org/10.1023/A:1015923202082
  3. Barone FC, White RF, Spera PA, et al. Ischemic preconditioning and brain tolerance: temporal histological and functional outcomes, protein synthesis requirement, and interleukin-1 receptor antagonist and early gene expression. Stroke 1998;29:1937-50. https://doi.org/10.1161/01.STR.29.9.1937
  4. Soncul H, Oz E, Kalaycioglu S. Role of ischemic preconditioning on ischemia-reperfusion injury of the lung. Chest 1999;115:1672-7. https://doi.org/10.1378/chest.115.6.1672
  5. Peralta C, Bartrons R, Serafin A, et al. Adenosine monophosphate-activated protein kinase mediates the protective effects of ischemic preconditioning on hepatic ischemia-reperfusion injury in the rat. Hepatology 2001;34:1164-73. https://doi.org/10.1053/jhep.2001.29197
  6. Davis JM, Gute DC, Jones S, et al. Ischemic preconditioning prevents postischemic P-selectin expression in the rat small intestine. Am J Physiol 1999;277:H2476-81.
  7. Gurke L, Mattei A, Chaloupka K, et al. Mechanisms of ischemic preconditioning in skeletal muscle. J Surg Res 2000; 94:18-27. https://doi.org/10.1006/jsre.2000.5987
  8. Berggren A, Weiland AJ, Ostrup LT, et al. Microvascular free bone transfer with revascularization of the medullary and periosteal circulation or the periosteal circulation alone. A comparative experimental study. J Bone Joint Surg Am 1982; 64:73-87. https://doi.org/10.2106/00004623-198264010-00012
  9. Kalebo P, Johansson C, Albrektsson T. Temporary bone tissue ischemia in the hind limb of the rabbit. A vital microscopic study. Arch Orthop Trauma Surg 1986;105:321-5. https://doi.org/10.1007/BF00449935
  10. Menger MD, Laschke MW, Amon M, et al. Experimental models to study microcirculatory dysfunction in muscle ischemia-reperfusion and osteomyocutaneous flap transfer. Langenbecks Arch Surg 2003;388:281-90. https://doi.org/10.1007/s00423-003-0426-y
  11. Opie LH. Myocardial ischaemia: metabolism and its modification. S Afr Med J 1987;72:740-7.
  12. Marijic J, Stowe DF, Turner LA, et al. Differential protective effects of halothane and isoflurane against hypoxic and reoxygenation injury in the isolated guinea pig heart. Anesthesiology 1990;73:976-83. https://doi.org/10.1097/00000542-199011000-00027
  13. Rucker M, Schafer T, Roesken F, et al. Local heat-shock priming-induced improvement in microvascular perfusion in osteomyocutaneous flaps is mediated by heat-shock protein 32. Br J Surg 2001;88:450-7. https://doi.org/10.1046/j.1365-2168.2001.01682.x
  14. Schott RJ, Rohmann S, Braun ER, et al. Ischemic preconditioning reduces infarct size in swine myocardium. Circ Res 1990;66:1133-42. https://doi.org/10.1161/01.RES.66.4.1133
  15. Manson PN, Anthenelli RM, Im MJ, et al. The role of oxygen-free radicals in ischemic tissue injury in island skin flaps. Ann Surg 1983;198:87-90. https://doi.org/10.1097/00000658-198307000-00017
  16. Yoshimura M, Shimamura K, Iwai Y, et al. Free vascularized fibular transplant. A new method for monitoring circulation of the grafted fibula. J Bone Joint Surg Am 1983;65:1295-301. https://doi.org/10.2106/00004623-198365090-00011
  17. Zahir KS, Syed SA, Zink JR, et al. Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model. Plast Reconstr Surg 1998;102:140-50. https://doi.org/10.1097/00006534-199807000-00022
  18. Sharifi P, Yunessi F, Sasani M, et al. The effects of transcutaneous electrical stimulation on the healing of radial fracture in rabbit. Am J Anim Vet Sci 2006;1:13-6. https://doi.org/10.3844/ajavsp.2006.13.16
  19. Turek SL. Reparo da fratura simples de um osso longo. In: Turek SL, editor. Ortopedia: principios e sua aplicacao. Sao Paulo: Manole; 1991. p.58-62.
  20. Whelan DB, Bhandari M, McKee MD, et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br 2002;84:15-8. https://doi.org/10.1302/0301-620X.84B1.11347
  21. Greenbaum MA, Kanat IO. Current concepts in bone healing. Review of the literature. J Am Podiatr Med Assoc 1993;83:123-9. https://doi.org/10.7547/87507315-83-3-123
  22. Kawai T, Murakami S, Hiranuma H, et al. Radiographic changes during bone healing after mandibular fractures. Br J Oral Maxillofac Surg 1997;35:312-8. https://doi.org/10.1016/S0266-4356(97)90402-2
  23. Katori M, Buelow R, Ke B, et al. Heme oxygenase-1 overexpression protects rat hearts from cold ischemia/reperfusion injury via an antiapoptotic pathway. Transplantation 2002; 73:287-92. https://doi.org/10.1097/00007890-200201270-00023
  24. Hutter MM, Sievers RE, Barbosa V, et al. Heat-shock protein induction in rat hearts. A direct correlation between the amount of heat-shock protein induced and the degree of myocardial protection. Circulation 1994;89:355-60. https://doi.org/10.1161/01.CIR.89.1.355