Augmentation of skeletal muscle survival in the latissimus dorsi porcine model using acute ischemic preconditioning

Abstract

Reconstruction of head and neck defects commonly involve local and distal muscle transplants. Ischemic flap necrosis is a well recognized complication of autogenous muscle transplants. Research in the field of myocardial survival has recently shown that repeated brief periods of ischemia followed by reperfusion result in improve muscle survival when the cardiac muscle is subsequently subjected to prolonged ischemia. This is called preconditioning and the mechanism is unknown. The concept is discussed in this paper and presented as a potential new, non-pharmacological strategy to reduce skeletal muscle ischemic necrosis. A review of the development and application of preconditioning in myocardial muscle survival is presented, and causes of ischemic muscle necrosis are discussed. Potential mechanisms of preconditioning in muscle are also presented. The extrapolation of the concept of preconditioning is discussed with an examination of a potential experimental model to test this concept: the latissimus dorsi flap in the pig. The results of our investigations into the effect of preconditioning on skeletal muscle and its possible mechanism are discussed. Preconditioning may prove to be a useful method to improve skeletal muscle tolerance to sustained normothermic global ischemia. This may have important clinical benefits in muscle transplantation. To our knowledge, this is the first publication to discuss the application of preconditioning in skeletal muscle.