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1.  Acute effects of remote ischemic preconditioning on cutaneous microcirculation - a controlled prospective cohort study 
BMC Surgery  2011;11:32.
Background
Therapeutic strategies aiming to reduce ischemia/reperfusion injury by conditioning tissue tolerance against ischemia appear attractive not only from a scientific perspective, but also in clinics. Although previous studies indicate that remote ischemic intermittent preconditioning (RIPC) is a systemic phenomenon, only a few studies have focused on the elucidation of its mechanisms of action especially in the clinical setting. Therefore, the aim of this study is to evaluate the acute microcirculatory effects of remote ischemic preconditioning on a distinct cutaneous location at the lower extremity which is typically used as a harvesting site for free flap reconstructive surgery in a human in-vivo setting.
Methods
Microcirculatory data of 27 healthy subjects (25 males, age 24 ± 4 years, BMI 23.3) were evaluated continuously at the anterolateral aspect of the left thigh during RIPC using combined Laser-Doppler and photospectrometry (Oxygen-to-see, Lea Medizintechnik, Germany). After baseline microcirculatory measurement, remote ischemia was induced using a tourniquet on the contralateral upper arm for three cycles of 5 min.
Results
After RIPC, tissue oxygen saturation and capillary blood flow increased up to 29% and 35% during the third reperfusion phase versus baseline measurement, respectively (both p = 0.001). Postcapillary venous filling pressure decreased statistically significant by 16% during second reperfusion phase (p = 0.028).
Conclusion
Remote intermittent ischemic preconditioning affects cutaneous tissue oxygen saturation, arterial capillary blood flow and postcapillary venous filling pressure at a remote cutaneous location of the lower extremity. To what extent remote preconditioning might ameliorate reperfusion injury in soft tissue trauma or free flap transplantation further clinical trials have to evaluate.
Trial registration
ClinicalTrials.gov: NCT01235286
doi:10.1186/1471-2482-11-32
PMCID: PMC3231986  PMID: 22111972
Remote ischemic preconditioning; cutaneous microcirculation; free flap; soft tissue
2.  Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation – an animal study 
Background
Treatment of ruptured Achilles tendons currently constitutes of conservative early functional treatment or surgical treatment either by open or minimal invasive techniques. We hypothesize that an experimental Achilles tendon suture in an animal model significantly deteriorates Achilles tendon microcirculation immediately following suturing.
Methods
Fifteen Achilles tendons of eight male Wistar rats (275–325 g) were included. After preparation of the Achilles tendon with a medial paratendinous approach, Achilles tendon microcirculation was assessed using combined Laser-Doppler and spectrophotometry (Oxygen-to-see) regarding:
- tendinous capillary blood flow [arbitrary units AU]
- tendinous tissue oxygen saturation [%]
- tendinous venous filling pressure [rAU]
The main body of the Achilles tendon was measured in the center of the suture with 50 Hz. 10 minutes after Achilles tendon suture (6-0 Prolene), a second assessment of microcirculatory parameters was performed.
Results
Achilles tendon capillary blood flow decreased by 57% following the suture (70 ± 30 AU vs. 31 ± 16 AU; p < 0.001). Tendinous tissue oxygen saturation remained at the same level before and after suture (78 ± 17% vs. 77 ± 22%; p = 0.904). Tendinous venous filling pressure increased by 33% (54 ± 16 AU vs. 72 ± 20 AU; p = 0.019) after suture.
Conclusion
Achilles tendon suture in anaesthetised rats causes an acute loss of capillary perfusion and increases postcapillary venous filling pressures indicating venous stasis. The primary hypothesis of this study was confirmed. In contrast, tendinous tissue oxygen saturation remains unchanged excluding acute intratendinous hypoxia within the first 10 minutes after suture. Further changes of oxygen saturation remain unclear. Furthermore, it remains to be determined to what extent reduced capillary blood flow as well as increased postcapillary stasis might influence tendon healing from a microcirculatory point of view in this animal setting.
doi:10.1186/1749-799X-4-32
PMCID: PMC2731078  PMID: 19674439
3.  Classification and management of early complications in open lumbar microdiscectomy 
European Spine Journal  2002;12(3):239-246.
Abstract.
Complications and side effects in any kind of surgery, especially in spine surgery, should be evaluated to prevent those problems in the future. Since retrospective studies are of minor value and randomized controlled studies for complications are impossible to perform because of ethical and legal reasons, so-called "expert opinion" has to take their place in evidence-based medicine. On the basis of an analysis of the results of three spine centers together with the opinions of experienced spine surgeons, the authors have drawn up a classification of complications in open lumbar disc surgery and recommendations on how to manage common complications such as excessive bleeding, dural opening, nerve root lesions and recurrent disc herniation. The management of intraoperative complications should have the same training in microdiscectomy instructional courses as the operation itself.
doi:10.1007/s00586-002-0466-y
PMCID: PMC3615492  PMID: 12799998
Microdiscectomy Complications of spine surgery Dural tears

Results 1-3 (3)