Acute effects of remote ischemic preconditioning on cutaneous microcirculation - a controlled prospective cohort study

Microcirculatory data of 27 healthy subjects (25 males, age 24 ± 4 years, BMI 23.3) were evaluated continuously at the anterolateral aspect of the left thigh during RIPC using combined Laser-Doppler and photospectrometry (Oxygen-to-see, Lea Medizintechnik, Germany). After baseline microcirculatory measurement, remote ischemia was induced using a tourniquet on the contralateral upper arm for three cycles of 5 min.After RIPC, tissue oxygen saturation and capillary blood flow increased up to 29% and 35% during the third reperfusion phase versus baseline measurement, respectively (both p = 0.001). Postcapillary venous filling pressure decreased statistically significant by 16% during second reperfusion phase (p = 0.028).Remote intermittent ischemic preconditioning affects cutaneous tissue oxygen saturation, arterial capillary blood flow and postcapillary venous filling pressure at a remote cutaneous location of the lower extremity. To what extent remote preconditioning might ameliorate reperfusion injury in soft tissue trauma or free flap transplantation further clinical trials have to evaluate.ClinicalTrials.gov: NCT01235286In several medical specialties, reduction of ischemia/reperfusion injury is a major topic. In trauma surgery, soft tissue defects after trauma due to accidents or due to operative trauma are quite common. In plastic and reconstructive surgery, on the other hand, soft tissue coverage is commonly performed using local or free flaps. Despite remarkable progress in surgical techniques and postoperative free flap monitoring devices over the last decades, free flap surgery is still associated with a significant morbidity. Current scientific literature reports a total loss rate of microsurgically transferred free flaps in one to five percent [1,2]. The main reasons are either persistent postoperative ischemia and hypoxia or transient ischemia associated with ischemia reperfusion injury [3]. Reducing or preventing soft tissue or free flap necrosis by condit