Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial

Area of Science:

• Microsurgery
• Oncology
• Vascular Surgery

Background:

• Free flap failure occurs in 5% of head and neck microsurgical reconstructions.
• Ischemia-reperfusion injury is a key factor contributing to flap failure.
• Remote ischemic preconditioning (RIPC) is a potential intervention to mitigate this injury.

Purpose of the Study:

• To evaluate the efficacy of RIPC in improving clinical outcomes for head and neck cancer patients undergoing microsurgical reconstruction.
• To determine if RIPC can reduce the rate of free flap failure.

Main Methods:

• A randomized controlled trial included head and neck cancer patients undergoing tumor resection and microsurgical reconstruction.
• Patients were randomized to receive RIPC or a sham intervention intraoperatively.
• RIPC involved four 5-minute periods of upper extremity occlusion and reperfusion.

Main Results:

• Sixty patients were randomized (30 RIPC, 30 sham).
• Flap failure rates at 30 days were 7% (RIPC) and 3% (sham) (P=1.0).
• Pedicle thrombosis occurred in 10% of patients in both groups (P=1.0).

Conclusions:

• Remote ischemic preconditioning (RIPC) is a safe and feasible intervention in this patient population.
• RIPC did not significantly affect clinical outcomes, including flap failure and thrombosis rates.
• The study suggests RIPC does not improve outcomes in head and neck microsurgical reconstruction.