Abstract
Background Ischemia-reperfusion injury plays an important role in flap failure. Ischemic preconditioning
technique is the only proven method for preventing ischemia-reperfusion injury, but
it is not used widely in daily practice because of difficulties such as prolonging
the operation time, need for surgical experience, and increasing the risk of complications.
This study has been performed with the assumption that piracetam may be a simple and
inexpensive alternative to the preconditioning technique due to its antioxidant, antiaggregant,
rheological, anti-inflammatory, antiapoptotic, cytoprotective, and immune modulating
effects.
Methods Thirty-two rats were divided into four groups and latissimus dorsi musculocutaneous
flaps were raised. No extra procedure was applied, and no treatment was given to the
control group. Four hours of ischemia was created by clamping the thoracodorsal pedicle
in the second group. The animals in the third group were treated with 10 minutes of
ischemia and reperfusion periods as a preconditioning procedure before the 4 hours
of ischemia. Animals in the fourth group received systemic piracetam 30 minutes before
and 6 days after reperfusion. Nitric oxide and myeloperoxidase levels in serum and
tissue, acute inflammatory cell response, and vascular proliferation in tissue were
examined at the postoperative 24th hour and 10th day.
Results Myeloperoxidase activity in both preconditioning and piracetam groups, was significantly
lower than the ischemia-reperfusion group. Acute inflammatory cell response was similarly
decreased in both preconditioning and piracetam groups compared with ischemia-reperfusion
group. Tissue measurements of nitric oxide were also significantly higher in both
preconditioning and piracetam groups than in the ischemia-reperfusion group. However,
vascular proliferation increased in the preconditioning group, while it did not show
any significant change in the piracetam group.
Conclusion This study shows that systemic piracetam treatment provides protection against ischemia-reperfusion
injury in musculocutaneous flaps and can offer a simple and inexpensive alternative
to the preconditioning technique.
Keywords
ischemia-reperfusion injury - latissimus dorsi - microvascular free flap operations
- piracetam
