Ischemic preconditioning in arterialized venous flap: Temperature effects and monitoring

Abstract

Introduction

Arterialized venous flap, like any other flap, will undergo an ischemic reperfusion injury during its transfer process. To overcome this, ischemic preconditioning can be done to provide protection and enhanced flap survival. One of the reliable parameters of flap survival is its temperature. However, there was no recorded data regarding AVF's temperature or its monitoring. This research aimed to demonstrate the temperature effect of ischemic preconditioning on arterialized venous flap.

Method

Male Wistar Rats were randomly divided into 4 groups, consisting of 6 negative control groups, 8 positive control group (PS) rats that underwent an anastomosis of the superficial epigastric artery to the superficial epigastric vein, 8 experimental rat group 1 (EX1) that underwent 3 cycles of 5 minutes pre-anastomosis clamping with 3 cycles of 5 minutes each, and 8 experimental rats’ group 2 (EX2) with 3 cycles of 10 minutes. Flap's temperature was observed preoperatively and postoperatively from day 1 to day 7, day 14, and day 21 with an android-based thermal camera and recorded in Celsius degrees.

Results

All the flaps (N= 26) were vital. The temperature drop was seen in all anastomosed flaps compared to the negative control (30.37 vs. 25.08 vs. 23.77 vs. 25.27, p<0.05). A significant increase in temperature occurred on days 4 to 6 in Ex1 (33.62±1.820, 33.62±1.820, 32.40±1.627; p<0.05). As in the temperature trend, Ex2 is shown to have a stable temperature from day 2 until 21.

Conclusion

This study has recorded an increase in temperature in the early days of the creation of the arterialized venous flap at various timings of ischemic preconditioning. The flap's monitoring was easily observed with a thermal camera that can be implemented in humans.