Hypothesis: Ischemic rat epigastric adipocutaneous flaps, which are conditioned before being raised by remote ischemic preconditioning (RIPC), have greater survival than flaps that are preconditioned after being raised. Methods: Female Wistar rats had 8 x 12 cm abdominal adipocutaneous flaps raised on the medial branch of the superficial epigastric artery. Group I (Controls) had the flap elevated and pedicle clamped for 3 hours. Group II had RIPC by a tourniquet on the contra-lateral hind limb before the flap was dissected. Group III mimicked Group II plus had an infusion of a nitric oxide blocker. Group IV had the flap elevated prior to the RIPC of the hind limb. Results: Group II with RIPC before the flap was lifted had less tissue necrosis compared to controls and less tissue necrosis than Group IV where the flaps were raised before the RIPC. Pre-infusion of nitric oxide blocker before RIPC blocked the survival advantage conferred by the preconditioning. Flaps treated with RIPC exhibited an increase in phosphorylated p38 MAP kinase. Conclusion: Rat epigastric adipocutaneous flaps elevated after RIPC have greater survival following prolonged ischemia than flaps, which are raised prior to the RIPC. This may be due to phosphorylated p38 MAP kinase.