Preoperative cooling and warming of the donor site increase survival of skin flaps by the mechanism of ischaemic preconditioning: An experimental study in rats

Recent studies show that survival of skin flaps can be increased by ischaemic preconditioning with repeated cycles of ischaemia and reperfusion before prolonged ischaemia or raising of the flap. In this study three cycles of cooling and warming of rat dorsal skin were used to regulate skin blood flow and to induce three cycles of ischaemia and reperfusion. In 10 Sprague-Dawley rats three cycles of cooling (-18 degrees C ice pack) and warming (45 degrees C running water) were used to regulate skin blood flow before the flaps were raised. Caudally-based skin flaps 11 x 2 cm were then raised to the left of the dorsal midline and sutured back. In the control group (n = 9) the flap was raised and sutured back without any treatment. Viability was assessed after seven days and the survival area calculated with planimetry. Viability increased from a mean (SD) of 61 (6)% in the control group to 77 (7)% in the experimental group (p<0.0001). This study shows that preoperative cooling and warming of the donor site can be used to increase survival of skin flaps. The probable explanation is ischaemic preconditioning although the biochemical mechanism is unclear.