Remote ischemic conditioning improves orthostatic competence of cutaneous microcirculation and central hemodynamics

Abstract

Background:

In lower extremity free flap reconstructions, the fragile initial flap perfusion must adapt to orthostatic stress during mobilization, slowing rehabilitation. However, active measures to accelerate this flap training are lacking. Remote Ischemic Conditioning (RIC) has been shown to improve microcirculation, but previous findings are limited to immobilized patients and do not consider the blood pressure-lowering potential of RIC, which could counteract orthostatic regulation.

Objective:

To evaluate the effect of RIC on cutaneous perfusion and central hemodynamics during orthostatic stress.

Methods:

This before-and-after study included 20 healthy volunteers mobilized on a tilt table. One cycle without conditioning was followed by an RIC-cycle 24 h later. Cutaneous microcirculation was assessed using laser Doppler flowmetry and remission spectroscopy at the anterolateral thigh. Hemodynamic parameters were evaluated using noninvasive continuous finger blood pressure measurements.

Results:

RIC resulted in a less pronounced decline in blood flow and oxygen saturation levels below baseline during orthostatic stress (p < 0.003) and a greater increase above baseline during recovery (p < 0.001). Furthermore, post-conditional blood pressure increased more above baseline during orthostastic stress (p < 0.02) and recovery (p < 0.007).

Conclusions:

RIC may improve the orthostatic competence of cutaneous microcirculation and central hemodynamics, suggesting its potential to support flap training and earlier patient mobilization.