Aim: This experimental study is a randomized controlled trial that was designed to study the effect of acute remote ischemic preconditioning (ARIPC) on random skin flap survival in rats with and without recipient bed isolation. 
Methods: Thirty rats were divided into three equal groups. On the dorsal aspect of the rat a caudally based, random pattern skin flap 3x9 cm in dimensions was designed. In the first (control) group, the flap had only been elevated and repositioned in place without ARIPC. In the second group, the flap was elevated and repositioned after a protocol of ARIPC. In the third group, the same protocol of group II was followed but a silicone sheet was inserted beneath the flap to prevent neovascularization from the bed. The amount of flap necrosis was measured on the seventh postoperative day. 
Results: The second (ARIPC) group had the most improved skin flap survival rate (P< 0.0001) while the flap survival rate in the third and control groups was not statistically different (P>0.05). 
Conclusion: Acute remote ischemic preconditioning enhances random skin flap survival, when it is performed just before the flap harvest and the isolation of recipient bed abolishes this enhancing effect.