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ratio and Bcl‑2 mRNA expression level were higher in the 9. Nakao A, Kaczorowski DJ, Wang Y, Cardinal JS, Buchholz BM, Sugimoto R,
HBO + HRS group than in the HBO or HRS groups. Tobita K, Lee S, Toyoda Y, Billiar TR, McCurry KR. Amelioration of rat
cardiac cold ischemia/reperfusion injury with inhaled hydrogen or carbon
This study demonstrates the synergistic effect of HBO monoxide, or both. J Heart Lung Transplant 2010;29:544‑53.
preconditioning and HRS treatment. By combining the 10. Shingu C, Koga H, Hagiwara S, Matsumoto S, Goto K, Yohoi I, Noguchi T.
Hydrogen‑rich saline solution attenuates renal ischemia‑reperfusion injury.
advantages of HBO and HRS, improved flap survival and J Anesth 2010;24:569‑74.
ischemia tolerance can be used clinically. IR oxygen is 11. Buchholz BM, Kaczorowski DJ, Sugimoto R, Yang R, Wang Y, Billiar TR,
not a rare gas and can be readily accessed. However, the McCurry KR, Bauer AJ, Nakao A. Hydrogen inhalation ameliorates oxidative
application of hydrogen is challenging secondary to its stress in transplantation induced intestinal graft injury. Am J Transplant
2008;8:2015‑24.
explosive properties and the difficulty of transportation. 12. Zhao L, Wang YB, Qin SR, Ma XM, Sun XJ, Wang ML, Zhong RG. Protective
HRS avoids such problems and can be used in many effect of hydrogen‑rich saline on ischemia/reperfusion injury in rat skin flap.
clinical scenarios. The mechanism of the synergistic effect J Zhejiang Univ Sci B 2013;14:382‑91.
of HBO preconditioning and HRS treatment have not yet 13. Wang WZ, Baynosa RC, Zamboni WA. Update on ischemia‑reperfusion
injury for the plastic surgeon: 2011. Plast Reconstr Surg 2011;128:685e‑92e.
been fully elucidated, and further studies are required. 14. van den Heuvel MG, Buurman WA, Bast A, van der Hulst RR. Review:
A limitation of this study was the need for an additional ischaemia‑reperfusion injury in flap surgery. J Plast Reconstr Aesthet Surg
IR group with a placebo treatment which would have 2009;62:721‑6.
allowed the comparison of the effects of HBO treatment. 15. Harder Y, Amon M, Laschke MW, Schramm R, Rucker M, Wettstein R. An
With this group, the study would have been more old dream revitalized: preconditioning strategies to protect surgical flaps from
critical ischemia and ischaemia‑reperfusion injury. J Plast Reconstr Aesthet Surg
rigorous. 2008;61:503‑11.
16. Karaaslan O, Ulusoy MG, Kankaya Y, Tiftikcioglu YO, Kocer U, Kankaya D,
This study showed that compared to an IR group, the rate Karaaslan GM, Tuncer S, Berktas M. Protective effect of grape seed
of skin flap survival is improved, and cellular apoptosis extract against ischeaemia/reperfusion injury in a rat epigastric flap model.
is attenuated secondary to a synergistic effect of HBO J Plast Reconstr Aesthet Surg 2010;63:705‑10.
preconditioning and HRS treatment. 17. Aydogan H, Gurlek A, Parlakpinar H, Askar I, Bay‑Karabulut A, Aydogan N,
Fariz A, Acet A. Beneficial effects of caffeic acid phenethyl ester (CAPE) on
In conclusion, the synergistic application of HBO and the ischemia‑reperfusion injury in rat skin flaps. J Plast Reconstr Aesthet Surg
HRS showed a higher flap survival rate, which could be a 2007;60:563‑8.
combined treatment to improve skin flap survival against 18. Cetin C, Kose AA, Aral E, Colak O, Ercel C, Karabağli Y, Alataş O,
Eker A. Protective effect of fucoidin (a neutrophil rolling inhibitor) on
IR injury. ischemia reperfusion injury: experimental study in rat epigastric Island flaps.
Ann Plast Surg 2001;47:540‑6.
Financial support and sponsorship 19. Schoenberg MH, Beger HG. Reperfusion injury after intestinal ischemia.
Project supported by the National Natural Science Crit Care Med 1993;21:1376‑86.
Foundation of China (No. 81171874) and the Beijing 20. Ozmen S, Ayhan S, Demir Y, Siemionow M, Atabay K. Impact of gradual
Natural Science Foundation (No. 7132169). blood flow increase on ischaemia‑reperfusion injury in the rat cremaster
microcirculation model. J Plast Reconstr Aesthet Surg 2008;61:939‑48.
Conflicts of interest 21. Chen H, Sun YP, Hu PF, Liu WW, Xiang HG, Li Y, Yan RL, Su N, Ruan CP,
There are no conflicts of interest. Sun XJ, Wang Q. The effects of hydrogen‑rich saline on the contractile
and structural changes of intestine induced by ischemia‑reperfusion in rats.
J Surg Res 2011;167:316‑22.
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338 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015