Modelling Direct Ischemic Preconditioning in Arteriovenous Flap: Is It Safe?

Abstract

Background: Edema and congestion are drawbacks in Arterialized venous free flap (AVF) that lead to flap necrosis. Ischemic preconditioning (IPC) is the procedure of alternate episodes of occlusion and non-occlusion in the feeding vasculature to promote protection against flap necrosis caused by ischemia-reperfusion. 

Objective: To determine the efficacy of IPC in AVF.

Method: In this experimental study, 24 male Wistar rats were divided into 3 groups: standard AVF (PS), AVF with 5-minute IPC (Ex-1), and AVF with 10-minute IPC (Ex-2). 3x3 cm skin flap created in left abdomen and arteriovenous anastomosis at epigastric vasculature.  The clinical condition was examined to determine the congestion and necrotic area extent. A mean comparison test was used to analyze the data. Using p<0.05, the results' significance was evaluated. 

Results: 20 flaps were vital. As for congestion, the Ex-1 group had a lower mean value (day 14th = 4.51 ± 6.799; day 21st = 0.00). In the study of the congested area from the immediate to the 21st day postoperatively, all groups had significant results with p<0.05. However, in the PS group, necrotic tissue was obtained with a mean end (day 14th = 4.34 ± 9.147; day 21st = 0.00), and no necrotic areas were found in the SHAM, Ex-1, and Ex-2 groups. In contrast, the area of necrotic tissue immediately up to the day 21st postoperatively did not show any significant results with p>0.05. 

Conclusion: Direct IPC is safe when creating AVF. It affects reducing congestion and necrotic areas.