The protective effect of L-arginine on ischemia-reperfusion injury in rat skin flaps Journal Article

Authors: Cordeiro, P. G.; Mastorakos, D. P.; Hu, Q. Y.; Kirschner, R. E.
Article Title: The protective effect of L-arginine on ischemia-reperfusion injury in rat skin flaps
Abstract: The objective of this study was to examine whether the administration of L-arginine, a precursor of nitric oxide and substrate of nitric oxide synthase, prior to reperfusion could lead to decrease in neutrophil-mediated tissue injury and improved flap survival. Epigastric island skin flaps were elevated in 70 rats and rendered ischemic. Thirty minutes prior to reperfusion, the rats were treated with intraperitoneal saline (n = 15), L- arginine (n = 15), D-arginine (n = 15), or N(ω)-nitro-L-arginine methylester plus L-arginine in equimolar amounts (n = 15). Flap survival at 7 days and neutrophil counts at 24 hours were evaluated. Flap necrosis as expected in the sham group of animals (n = 10) was 0.0 percent, while the control (saline-treated) animals had 59.6 percent necrosis. Animals treated with L- arginine demonstrated a significant decrease in flap necrosis to 12.7 percent. This protective effect was almost completely negated by N(ω)- nitro-L-arginine methylester, which significantly increased flap necrosis to 49.3 percent and was much less pronounced with D-arginine (28.6 percent). Neutrophil counts were significantly decreased in flaps from L-arginine- treated and sham animals versus both saline and N(ω)-nitro-L-arginine methylester-treated groups. We conclude that administration of L-arginine prior to reperfusion can significantly reduce the extent of flap necrosis and flap neutrophil counts due to ischemia-reperfusion injury. This protective effect is completely negated by nitric oxide synthase inhibition. Since L- arginine reduces the number of neutrophils within the flap and the extent of flap necrosis only in the presence of active nitric oxide synthase, we hypothesize that this protective effect of L-arginine on ischemia-reperfusion injury is secondary to a nitric oxide-mediated suppression of neutrophil- mediated injury.
Keywords: controlled study; surgical flaps; nonhuman; animals; animal tissue; enzyme inhibition; animal experiment; animal model; necrosis; postoperative complication; neutrophil; ischemia; rat; rats; leukocyte count; graft survival; inflammatory infiltrate; rats, sprague-dawley; skin necrosis; arginine; reperfusion injury; female; priority journal; article; skin island flap; ng-nitroarginine methyl ester; dextro arginine; n(g) nitroarginine methyl ester
Journal Title: Plastic and Reconstructive Surgery
Volume: 100
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 1997-10-01
Start Page: 1227
End Page: 1233
Language: English
DOI: 10.1097/00006534-199710000-00023
PUBMED: 9326784
PROVIDER: scopus
Notes: Article -- Export Date: 17 March 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Peter G Cordeiro
    271 Cordeiro
  2. Qun Ying Hu
    27 Hu