Abstract
BackgroundInsufficient arterial blood flow is the one cause of flap necrosis. Cilostazol is an inhibitor of phosphodiesterase III and increases cyclic AMP level in vascular smooth muscle cell causing vasodilation. Therefore, effect of cilostazol is expected to improve the viability of the flap.MethodsDouble blinded randomized controlled trial was conducted. The study was to compare the survival of dorsal rat flaps between preoperative cilostazol supplemented diet and regular diet. The flap survival area was measured using PixArea Image software on post operative day 1,3,5 and 7. Fluorescein injection was performed to evaluate the exactly area of flap survival on postoperative day 7 and morphology of arterioles and venules were examined by histopathologic examination.ResultsA statistical significance was found in the percentage of area of flap survival between cilostazol supplemented diet and control group on postoperative day 3, 5 and 7 (p < 0.05). Fluorescein injection showed the higher area of flap survival in cilostazol group than the control group (p < 0.05). Histopathologic examination showed dilation of vessels in the cilostazol group.ConclusionPreoperative cilostazol in rats can enhance skin flap survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s13022-015-0011-4) contains supplementary material, which is available to authorized users.
Highlights
Insufficient arterial blood flow is the one cause of flap necrosis
Partial flap necrosis was observed on the distal part of the flap on day1,3,5 and 7 after flap elevation (Table 1) (Figure 2)
The results between the groups administrated with pre-operative cilostazol and the control group were statistical significant on day 3, 5 and 7(p < 0.05)
Summary
Insufficient arterial blood flow is the one cause of flap necrosis. Cilostazol is an inhibitor of phosphodiesterase III and increases cyclic AMP level in vascular smooth muscle cell causing vasodilation. Effect of cilostazol is expected to improve the viability of the flap. Flap necrosis is demonstrated by insufficient arterial flow, inadequate venous drainage or combination of both [1,2]. Delay flap procedure increase the viability, disadvantage of this technique is requiring second operations [3,4,5,6,7]. Many pharmacological agents [8] have been introduced to Cilostazol is a selective inhibitor of phosphodiesterase type III, by which it increases intracellular cyclic AMP (cAMP) and raises the vascular smooth muscle cell’s cAMP level causing vasodilation. It is benefit to treat patients suffering from intermittent claudication without rest pain and no peripheral tissue necrosis as it improves pain-free walking distances
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