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Original Article Plastic and Aesthetic Research

Synergistic effect of hyperbaric oxygen

preconditioning and hydrogen-rich saline in

ameliorating rat flap ischemia/reperfusion

injury

Yi-Ding Xiao , Yun-Qi Liu , Ming-Zi Zhang , You-Bin Wang , Yi-Fang Liu , Xue-Mei Ma 2
1
1
1
2
2
1 Department of Plastic Surgery, Peking Union Medical College Hospital, Dongcheng 100730, Beijing, China.
2 College of Life Science and Bioengineering, Beijing University of Technology, Chaoyang 100124, Beijing, China.
Address for correspondence: Dr. You-Bin Wang, Department of Plastic Surgery, Peking Union Medical College Hospital, Dongcheng 100730,
Beijing, China. E-mail: wybenz@sina.com
ABSTRACT
Aim: This study was conducted to evaluate the synergistic effects of hyperbaric oxygen (HBO)
preconditioning and hydrogen-rich saline (HRS) treatment on skin flap survival and apoptosis in a
rat ischemia/reperfusion (IR) skin flap model. Methods: Male Sprague-Dawley rats were randomly
divided into five groups: one sham surgery group (sham group) and four surgery groups (IR group, HBO
group, HRS group, and HBO + HRS group). An extended epigastric adipocutaneous flap (6 cm × 9 cm)
was raised over the abdomen in each animal of all five groups. The last four groups underwent 6 h of
IR management and were treated, respectively, with normal saline, HBO, HRS (HRS, 0.8 mmol/L), or
a combined approach (HBO and HRS). On the 3rd postoperative day, flap survival rate and perfusion
condition, apoptotic index, caspase-3 activity, protein expression of pASK1 and Bcl-2/Bax ratio,
and Bcl-2 messenger RNA (mRNA) expression were assessed. Results: Prior studies have shown
the protective effects of HBO and HRS, both of which have been associated with an increase in flap
survival. Compared to the IR group, the flaps in the HBO, HRS, and HBO + HRS groups showed
better perfusion and a larger survival area with a low number of apoptotic cells, low caspase-3 activity
and pASK1 expression, and a high Bcl-2/Bax ratio and Bcl-2 mRNA expression. Of these groups, the
HBO + HRS group showed the best flap survival. Conclusion: Both HBO and HRS treatments increase
the rate of flap survival, while the synergistic application of HBO and HRS showed a higher survival
rate as compared to individual treatments of each. The potential regulation of apoptosis with the use
of these two modalities may improve skin flap survival.

Key words:
Apoptosis, hydrogen-rich saline, hyperbaric oxygen, ischemia/reperfusion injury, skin flaps

INTRODUCTION remains a challenging problem. In a report by Chen et al.,
[1]
113 cases (9.9%) out of 1,142 free flap operations had
Although the transfer of skin flaps is widely used in
wound coverage and reconstruction, soft tissue necrosis This is an open access article distributed under the terms of the Creative Commons
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How to cite this article: Xiao YD, Liu YQ, Zhang MZ, Wang YB,
Liu YF, Ma XM. Synergistic effect of hyperbaric oxygen preconditioning
and hydrogen-rich saline in ameliorating rat flap ischemia/reperfusion
DOI:
10.4103/2347-9264.169499 injury. Plast Aesthet Res 2015;2:332-9.
Received: 24-04-2015; Accepted: 27-10-2015

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