J Reconstr Microsurg
DOI: 10.1055/s-0040-1717102
Original Article

Effects of Ischemic Preconditioning and C1 Esterase Inhibitor Administration following Ischemia-Reperfusion Injury in a Rat Skin Flap Model

Inmaculada Masa
1  Department of Plastic and Reconstructive Surgery, University Hospital Clínico San Carlos, Madrid, Spain
César Casado-Sánchez
2  Department of Plastic and Reconstructive Surgery, University Hospital La Paz, Madrid, Spain
Vicente Crespo-Lora
3  Department of Pathology, University of Granada, Granada, Spain
4  Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
› Author Affiliations


Background Ischemia-reperfusion (I/R) injury is a serious condition that can affect the success rate of microsurgical reconstructions of ischemic amputated limbs and complex tissue defects requiring free tissue transfers. The purpose of this study was to evaluate the effects of ischemic preconditioning (IPC) and C1 esterase inhibitor (C1-Inh) intravenous administration following I/R injury in a rat skin flap model.

Methods Superficial caudal epigastric skin flaps (3 cm × 7 cm) were performed on 50 Wistar rats that were randomly divided into five groups. Ischemia was not induced in the control group. All other flaps underwent 8 hours of ischemia prior to revascularization: I/R control group (8-hour ischemia), IPC group (preconditioning protocol + 8-hour ischemia), C1-Inh group (8-hour ischemia + C1-Inh), and IPC + C1-Inh group (preconditioning protocol + 8-hour ischemia + C1-Inh). Survival areas were macroscopically assessed after 1 week of surgery, and histopathological and biochemical evaluations were also measured.

Results There were no significant differences in flap survival between the treatment groups that were suffering 8 hours of ischemia and the control group. A significant increase in neovascularization and lower edema formation were observed in the IPC group compared with that in the I/R group. Biochemical parameters did not show any significant differences.

Conclusion Intravenous administration of C1-Inh did not significantly modulate I/R-related damage in this experimental model, but further research is needed. On the other hand, IPC reduces tissue damage and improves neovascularization, confirming its potential protective effects in skin flaps following I/R injury.

Publication History

Received: 01 May 2020

Accepted: 18 August 2020

Publication Date:
24 September 2020 (online)

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