Ischaemic insult in the skin flaps is a major problem in reconstructive surgery particularly in patients with diabetes mellitus.\nHere, we sought to investigate the effectiveness of ischaemic preconditioning (IP) on diabetic skin flaps in rat animal model.\nHundredWistar rats (90 streptozotocin treated animals and 10 nondiabetic controls) were used. Diabetes mellitus was confirmed\nby measuring glucose level in blood, HbA1c, and ketonuria.We used blood vessel clamping, hind limb tourniquet, and NO donors\n(Spermine/NO complex) to induce short-term ischaemia of tissues that will be excised for skin flaps. Animals were followed\nfor 5 days. Flaps were photographed at day 5 and percent of necrosis was determined using planimetry. Significant decrease in\npercent of necrotic tissue in all groups that received preconditioning was observed. Results show that ischaemic preconditioning\nsuppresses flap necrosis in diabetic rats irrespective of direct or remote tissue IP and irrespective of chemically or physically induced\npreischaemia. Spermine/NO complex treatment 10 minutes after the flap ischaemia suppressed tissue necrosis. Treatment with NO\nsynthase inhibitor L-NAME reversed effects of IP showing importance of NO for this process. We show that IP is a promising\napproach for suppression of tissue necrosis in diabetic flaps and potential of NO pathway as therapeutic target in diabetic flaps.
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