Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial
Background:. The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia–reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia–reperfusion injury. The aim of the prese...
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doaj-445483dd11154c628036ecca880ac2812020-11-25T03:07:14ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742020-01-0181e259110.1097/GOX.0000000000002591202001000-00012Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled TrialAndreas E. Krag, MD0Anne-Mette Hvas, MD, PhD1Christine L. Hvas, MD, PhD2Birgitte J. Kiil, MD3From the * Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark† Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark§ Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.From the * Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, DenmarkBackground:. The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia–reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia–reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction. Methods:. Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were included in a randomized controlled trial. Patients were randomized (1:1) to RIPC or sham intervention administered intraoperatively just before transfer of the free flap. RIPC was administered by four 5-minute periods of upper extremity occlusion and reperfusion. Clinical data were prospectively collected in the perioperative period and at follow-up on postoperative days 30 and 90. Intention-to-treat analysis was performed. Results:. Sixty patients were randomized to RIPC (n = 30) or sham intervention (n = 30). All patients received allocated intervention. No patients were lost to follow up. At 30-day follow-up, flap failure occurred in 7% of RIPC patients (n = 2) and 3% of sham patients (n = 1) with the relative risk and 95% confidence interval 2.0 [0.2;20.9], P = 1.0. The rate of pedicle thrombosis was 10% (n = 3) in both groups with relative risk 1.0 [0.2;4.6], P = 1.0. The flap failure rate did not change at 90-day follow-up. Conclusions:. RIPC is safe and feasible but does not affect clinical outcomes in head and neck cancer patients undergoing microsurgical reconstruction.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002591 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andreas E. Krag, MD Anne-Mette Hvas, MD, PhD Christine L. Hvas, MD, PhD Birgitte J. Kiil, MD |
spellingShingle |
Andreas E. Krag, MD Anne-Mette Hvas, MD, PhD Christine L. Hvas, MD, PhD Birgitte J. Kiil, MD Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial Plastic and Reconstructive Surgery, Global Open |
author_facet |
Andreas E. Krag, MD Anne-Mette Hvas, MD, PhD Christine L. Hvas, MD, PhD Birgitte J. Kiil, MD |
author_sort |
Andreas E. Krag, MD |
title |
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial |
title_short |
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial |
title_full |
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial |
title_fullStr |
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial |
title_full_unstemmed |
Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial |
title_sort |
remote ischemic preconditioning in microsurgical head and neck reconstruction: a randomized controlled trial |
publisher |
Wolters Kluwer |
series |
Plastic and Reconstructive Surgery, Global Open |
issn |
2169-7574 |
publishDate |
2020-01-01 |
description |
Background:. The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia–reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia–reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction.
Methods:. Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were included in a randomized controlled trial. Patients were randomized (1:1) to RIPC or sham intervention administered intraoperatively just before transfer of the free flap. RIPC was administered by four 5-minute periods of upper extremity occlusion and reperfusion. Clinical data were prospectively collected in the perioperative period and at follow-up on postoperative days 30 and 90. Intention-to-treat analysis was performed.
Results:. Sixty patients were randomized to RIPC (n = 30) or sham intervention (n = 30). All patients received allocated intervention. No patients were lost to follow up. At 30-day follow-up, flap failure occurred in 7% of RIPC patients (n = 2) and 3% of sham patients (n = 1) with the relative risk and 95% confidence interval 2.0 [0.2;20.9], P = 1.0. The rate of pedicle thrombosis was 10% (n = 3) in both groups with relative risk 1.0 [0.2;4.6], P = 1.0. The flap failure rate did not change at 90-day follow-up.
Conclusions:. RIPC is safe and feasible but does not affect clinical outcomes in head and neck cancer patients undergoing microsurgical reconstruction. |
url |
http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002591 |
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