The rare sugar D-allose has a reducing effect against ischemia-reperfusion injury on the rat abdominal skin island flap model Gan Muneuchi, MD, a, * Akram Hossain, MD, PhD, b Fuminori Yamaguchi, MD, PhD, b Masaki Ueno, MD, PhD, c Yoshio Tanaka, MD, PhD, a Shigehiko Suzuki, MD, PhD, d and Masaaki Tokuda, MD, PhD b a Department of Plastic and Reconstructive Surgery, Kagawa University, Kagawa, Japan b Department of Cell Physiology, Kagawa University, Kagawa, Japan c Department of Pathology and Host Defense, Kagawa University, Kagawa, Japan d Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan article info Article history: Received 21 December 2012 Received in revised form 20 February 2013 Accepted 1 March 2013 Available online 21 March 2013 Keywords: D-allose Rare sugar Ischemia-reperfusion injury Skin island flap Antioxidant Myeloperoxidase (MPO) Neutrophil abstract Background: Recently, one of the rare sugars, D-allose, has received attention from many researchers because of its availability for mass production and its various physiological functions. Among these, an antioxidative effect has been strongly suggested. In this study, we investigated whether this effect is also applicable to the field of skin surgery. Methods: In ischemia-reperfusion injury model using the rat abdominal skin island flap (male Wistar rats, n ¼ 110), D-allose was injected intravenously 15 min before 8-h ischemia. The survival area (%) was measured by digital photographic assessment 1 wk after surgery, and multiple comparisons (Fisher’s protected least significant difference) were carried out. Histopathological examination (neutrophilic infiltration into dermis in hematoxylin and eosin stain) and immunostaining (of ectodermal dysplasia-1 (ED1)-positive cells/flap) were assessed. Myeloperoxidase (MPO) activity in the skin flap (sampling at the time of 8 h after reperfusion) was measured spectrophotometrically, and Student t-test was performed. Results: D-allose extended the survival of the remaining flaps, and a dose greater than 30 mg (0.1 mg/g) was necessary to be effective. The flap survival rates in the 30, 60, and 150 mg groups were significantly higher than that in the control (saline) group: 75.87  5.90, 79.27  7.81, and 77.87  6.20 versus 50.53  9.66, respectively (P < 0.05). ED1-positive cells/flap in 60 mg of D-allose and control (saline) were 78  25.7 versus 124  15.8, respectively (P ¼ 0.08). The MPO activity in the D-allose 60 mg group was 0.40  0.04, and that in the control (saline) was 0.72  0.12. D-allose significantly reduced the skin tissue MPO activity (P < 0.05) compared with that in the control (saline) group. Conclusions: We proved that D-allose has a reducing effect against ischemia-reperfusion injury on the skin island flap model, and the mechanism is related to inhibiting the activity of neutrophils in the skin tissues. Compared with chemo-synthetic materials, * Corresponding author. Department of Plastic and Reconstructive Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. Tel.: þ81 87 891 2198; fax: þ81 87 891 2199. E-mail address: muneuchi@med.kagawa-u.ac.jp (G. Muneuchi). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 183 (2013) 976 e981 0022-4804/$ e see front matter ª 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2013.03.006