Abstract
Background Ischemia-reperfusion (I/R) injury by abrupt restoration of circulation after prolonged
ischemia has still been an unsolved problem in plastic and reconstructive surgery.
The concept of postconditioning (post-con), which has been well described in cardiovascular
surgery, has been recently introduced in plastic and reconstructive surgery. As an
“after-injury strategy,” post-con may be a promising approach to reduce I/R injury
and improve flap survival after ischemia.
Methods A systematic review was performed by searching electronic databases of PubMed and
web of science to identify all the studies regarding the application of the post-con
technique in plastic and reconstructive surgery between 1950 and 2015. Inclusion criteria
were English articles with clear reporting the post-con techniques and detailed outcomes.
Results In total, 476 articles were identified and 18 studies reporting post-con in plastic
and reconstructive surgery met the inclusion criteria in this review, including 11
studies of mechanical post-con, 3 studies of pharmacological post-con, 1 study of
both mechanical and pharmacological post-con, and 3 studies of remote post-con. All
these studies reported protective effects of any kind of post-con techniques in I/R
injuries and could improve flap survivals.
Conclusion In general, the strategy of post-con may effectively reduce I/R injury and improve
the survival of flaps after ischemia in animal studies, yet no consensus regarding
the exact technical details (intervention timing, cycles, intermittent duration, etc.)
has been reached. Further studies aiming to explore its mechanisms as well as specific
methodology are required before clinical application in plastic and reconstructive
surgery.
Keywords
postconditioning - plastic and reconstructive surgery - ischemic and reperfusion injury
- surgical flaps - mechanisms
