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Krauss et al. Plast Aesthet Res 2018;5:39 Plastic and
DOI: 10.20517/2347-9264.2018.41 Aesthetic Research

Review Open Access

Tissue conditioning - strategies to improve
perfusion and reduce ischemia - reperfusion injury

Sabrina Krauss , Jens Rothenberger , Johannes Mayer , Alexander Sogorski , Manuel Held , Theodora
1
1
2
1
1
Wahler , Adrien Daigeler , Jonas Kolbenschlag 1
1
1
1 Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University Tuebingen,
Tuebingen 72076, Germany.
2 Department of Plastic Surgery, Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum 44789, Germany.
Correspondence to: Dr. Sabrina Krauss, Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen,
Eberhard Karl University Tuebingen, Tuebingen 72076, Germany. E-mail: SabrinaKrauss@gmx.net
How to cite this article: Krauss S, Rothenberger J, Mayer J, Sogorski A, Held M, Wahler T, Daigeler A, Kolbenschlag J. Tissue conditioning
- strategies to improve perfusion and reduce ischemia - reperfusion injury. Plast Aesthet Res 2018;5:39.
http://dx.doi.org/10.20517/2347-9264.2018.41

Received: 4 Jun 2018 First Decision: 13 Aug 2018 Revised: 10 Sep 2018 Accepted: 10 Sep 2018 Published: 29 Sep 2018
Science Editor: Raymund Engelbert Horch Copy Editor: Yuan-Li Wang Production Editor: Zhong-Yu Guo

Abstract

Ischemia as well as ischemia-reperfusion injury (IRI) can cause serious tissue damage and therefore is a feared
complication in reconstructive surgery. This is the reason why researchers around the world invest their efforts to
improve tissue viability after ischemic events. Tissue conditioning offers a broad scope of different techniques which
can be applied pre-, peri- or postoperatively to adapt the affected tissue to the subsequent stress during and after
ischemia to prevent or minimize IRI. The different ways of tissue conditioning in flap surgery include surgical delay,
ischemic conditioning, remote ischemic conditioning as well as thermic preconditioning and other techniques, using
growth factors, pharmaceutical agents, extracorporeal shock waves as well as stemm cells. Therefore, we want to shed
some light on the effects of ischemia and ischemia-reperfusion injury and further illustrate the different strategies of
tissue conditioning with special concern to flap surgery but also regarding wound healing in general.

Keywords: Tissue conditioning, ischemia, ischemia-reperfusion injury, reconstructive surgery, flap surgery, wound healing

INTRODUCTION
Cell damage caused by ischemia affects almost all clinical disciplines, seen in daily clinical routine for
example as heart attacks, strokes, in organ transplantations as well as in reconstructive surgical procedures
[1]
such as flap surgery . Ischemia as well as ischemia-reperfusion injury (IRI) represent a formidable challenge
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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