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Open Access
CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2779-2935
Original Article

Does Exsanguination Enhance Skin Microcirculation in Remote Ischemic Conditioning using a Tourniquet? A Randomized Controlled Trial on 50 Healthy Subjects.

Authors

  • Carola Rist

    1   Clinic for Hand-, Plastic-, Reconstructive and Burn Surgery, BG Clinic Tuebingen, Tuebingen, Germany

  • Jens Rothenberger

    1   Clinic for Hand-, Plastic-, Reconstructive and Burn Surgery, BG Clinic Tuebingen, Tuebingen, Germany

  • Adrien Daigeler

    1   Clinic for Hand-, Plastic-, Reconstructive and Burn Surgery, BG Clinic Tuebingen, Tuebingen, Germany

  • Andrea Wenger 

    1   Clinic for Hand-, Plastic-, Reconstructive and Burn Surgery, BG Clinic Tuebingen, Tuebingen, Germany
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Introduction: Remote Ischemic Conditioning (RIC) improves cutaneous microcirculation in free flap surgery. As no universal RIC-protocol exists, refinements have manily focused on cycle duration and number. We aimed to assess wether ischemic stimulus intensity, using a tourniquet with additional exsanguination, affects cutaneous microcirculation. Methods: In this randomized controlled trial, 50 healthy volunteers were randomized into two groups (25 each). Both underwent a RIC-protocol of 3 cycles of 10-minute ischemia followed by 10-minute reperfusion. In the control group (Tourniquet, T), ischemia was induced with a surgical tourniquet inflated to 250 mmHg on the right upper arm. In the experimental group (Tourniquet with exsanguination, Te), the arm was additionally exsanguinated using an Esmarch bandage. Cutaneous microcirculation parameters (oxygen saturation [SO2], blood flow [BF| and relative amount of hemoglobin [rHb]) were assessed non-invasively with the Oxygen-To-See (O2C) device. Results: Both groups showed significant changes in all microcirculatory parameters compared to baseline. Although SO2 and BF values tended to be higher during reperfusion in the experimental group (Te), overall differences were not statistically significant (except at the end of the first reperfusion phase in BF [Tmean 1.33+/-0.54 vs. Temean 1.93+/-0.91; p 0.017] and at the beginning of the second reperfusion phase in SO2 [Tmean 1.05+/-0.18 vs. Temean 1.13+/-0.17; p 0.045] respectively). Conclusion: Exsanguination in addition to tourniquet application does not enhance cutaneous microcirculation in RIC protocols. The relatively small sample size remains a limitation and restricts generalizability. Future studies should confirm these findings in larger and more diverse cohorts and explore potential clinical applications.



Publication History

Received: 30 August 2024

Accepted after revision: 25 December 2025

Accepted Manuscript online:
06 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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