Protective effect of hydrogen sulfide against ischemia-reperfusion injury in rat skin flaps

Aim: The aim of this study was to observe the effect of hydrogen sulfide (H2S) by creating ischemia-reperfusion injury (IRI) on the rat groin flap. Materials and Methods: Forty Wistar albino rats were divided into four groups. Subjects were examined in four groups: sham control, physiologic saline control, ischemia, and H2S group. Superficial epigastric artery pedicled island flap skin flaps were applied to all groups. In the sham control group, the flap was sutured into place without ischemia. In the ischemia group, no additional intervention was made to the flap before ischemia. In the saline control group, 1 mg/kg saline was administered through the tail vein 20 min before ischemia. In the H2S group, liquid H2S was administered through the tail vein 20 min before ischemia, with a final concentration of 10 mu M. After the rats were sacrificed, tissue samples were taken. Neutrophil count and malondialdehyde (MDA) levels were measured and IRI in the tissue was evaluated under an electron microscope. Results: Neutrophil count and MDA levels were statistically significantly different between the sham control group and the other groups (P < 0.001). However, the difference between the H2S, SF control, and ischemia groups in terms of neutrophil count and MDA levels was not statistically significant. Electron microscopic examinations showed that the H2S group was protected at the cellular level against IRI and apoptosis. Discussion: As a result of this study, the protective effects of H2S against IRI were seen at the cellular level using electron microscopy. However, due to the long ischemia time (6 h), it was observed that it did not affect tissue neutrophil counts and MDA levels, the end product of lipid peroxidation. We believe that if new studies involving different ischemia times with H2S are conducted, H2S can be used in clinical applications in free flap surgery.