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CC BY 4.0 · J Reconstr Microsurg Open 2025; 10(01): e19-e31
DOI: 10.1055/a-2624-2776
Original Article

Ischemic Preconditioning on Secondary Arterial and Venous Ischemia in Pedicled Axial Flaps in Wistar Rats

Maria Jesus Rivera
1   Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Universitario de Burgos, Complejo Asistencial Universitario de Burgos, Burgos, Spain
2   Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Regional Universitario de Málaga, Málaga, Spain
,
Monica Cavia-Saiz
3   Department of Biotechnology and Food Science, Universidad de Burgos, Burgos, Spain
,
Pilar Muñiz
3   Department of Biotechnology and Food Science, Universidad de Burgos, Burgos, Spain
,
María A. Risalde
4   Department of Anatomía y Anatomía Patológica Comparadas y Toxicología, Grupo de Investigación en Sanidad Animal y Zoonosis (GISAZ), UIC Zoonosis y Enfermedades Emergentes ENZOEM, Universidad de Córdoba, Córdoba, Spain
,
Angélica Martínez-Delgado
5   Department of Medicine and Experimental Surgery, Hospital Divino Vallés, Complejo Asistencial Universitario de Burgos, Burgos, Spain
6   Area of Didactics of Experimental Sciences, Department of Specific Didactics, Faculty of Education, Universidad de Burgos, Burgos, Spain
› Author Affiliations
Funding None.
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Abstract

Background Microvascular complications, particularly secondary arterial and venous ischemia, pose significant challenges in reconstructive surgery. This study investigates the potential protective effects of ischemic preconditioning on flap survival, anatomopathological alterations, and immunological responses in pedicled axial flaps subjected to secondary ischemia.

Methods Adult male Wistar rats underwent arterial or venous ischemia, with and without ischemic preconditioning. Histological assessments, immunohistochemistry studies, and biochemical analyses were conducted to evaluate the impact of ischemic preconditioning on inflammatory processes and tissue damage.

Results Ischemic preconditioning demonstrated a statistically significant decrease in histological lesions, with reductions of 56% in arterial and 47% in venous ischemia, mainly associated with a reduction of inflammatory changes and necrosis processes. Immunological analyses revealed a significant reduction in IgM levels induced by venous ischemia, and a consistent decrease in inflammatory cytokines (interleukin-1 and tumor necrosis factor alpha) in both arterial and venous ischemia following preconditioning. Furthermore, F2-isoprostane levels indicated a lower production of oxidative stress markers in preconditioned flaps.

Conclusion This study highlights the beneficial impact of ischemic preconditioning on flap viability, providing robust evidence of reduced histological lesions, inflammation, and oxidative stress in both arterial and venous secondary ischemia scenarios. These findings support the potential clinical relevance of incorporating ischemic preconditioning strategies to improve outcomes in microvascular reconstructive surgery.

Keywords

ischemic preconditioning - secondary - ischemia - arterial ischemia - venous ischemia

Note

Animal use described here complied with EU Directive 2010/63 and Spanish Government RD 53/2013 on the protection of animals used in experimentation with the permission from the Animal Welfare Committee (University Hospital of Burgos, reference: CEBA 22).




Publication History

Received: 13 October 2024

Accepted: 20 March 2025

Article published online:
16 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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