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[94]
factors and other angiogenic mediators in the wound bed . Remote ischemic conditioning for example has
also proven to be of use in diabetic patients. There are clinical studies that could show a significantly improved
healing of diabetic foot ulcers due to remote ischemic conditioning [95,96] . And the effects of extracorporeal
shock waves have been investigated in the clinical setting in burn patients as well. Researchers could show
better results in terms of wound healing because of its positive effects on angiogenesis [79,80,97] .

CONCLUSION
Despite all the progress made in plastic and especially flap surgery, total or partial flap loss caused by ischemia
or ischemia reperfusion-injury is still feared and has common complications. As temporary ischemia is
inevitable in free flaps and the tissue of pedicled flaps is initially exposed to changes in perfusion as well,
strategies to improve tissue viability are of vital importance. Many of the above mentioned, promising ways
of tissue conditioning have yet only been tested under laboratory conditions or in animal models so further
studies including clinical trials are needed. Those findings could not only offer great benefits in plastic surgery
but in other fields of medicine as well, including the treatment of extensive or chronic wounds as well as
[17]
transplant surgery. To lean on the words of Gillies , tissue conditioning harbors the possibility to be an
important weapon in the battle between beauty and blood supply.

DECLARATIONS
Authors’ contributions
Designed and wrote the article, performed literature research and produced the figures: Krauss S
Assisted in designing the article, offered ideas concerning content of the article, corrected the article and
proofread the final version: Kolbenschlag J
Read, corrected the article and discussed the content: Rothenberger J, Mayer J, Sogorski A, Held M, Wahler T,
Daigeler A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Consent for publication was obtained.

Copyright
© The Author(s) 2018.

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2. Messner F, Grahammer J, Hautz T, Brandacher G, Schneeberger S. Ischemia/reperfusion injury in vascularized tissue allotransplantation:
tissue damage and clinical relevance. Curr Opin Organ Transplant 2016;21:503-9.
3. Petruzzo P, Lanzetta M, Dubernard JM, Landin L, Cavadas P, Margreiter R, Schneeberger S, Breidenbach W, Kaufman C, Jablecki J,