Effect of Systemic Antioxidant Allopurinol Therapy on Skin Flap Survival.

Mehdi Rasti Ardakani ,Ahmed Al‐Dam ,Ashkan Rashad ,Ali Shayesteh Moghadam

doi:10.31700/2572-6684.000110

Abstract

It has been reported that systemic administration of allopurinol improves cell survival. This study was aimed to evaluate effects of allopurinol on skin flaps in dogs.Twenty dogs underwent one skin flap surgery with a 2-week interval. The first procedure was performed according to the standard protocols. The second phase was started by a 1-week pretreatment with allopurinol. Length of the necrotic zone was measured and recorded daily. At each phase, flaps were removed and sent for histopathological study after 1 week observation.Mean length of the necrotic zone in allopurinol treated skin flaps has been significantly less than normal flaps over all 7 days of observation (p<0.0001). Histopathology study showed less inflammation and more normal tissue structure in the allopurinol treated skin flaps.It was demonstrated that systemic administration of allopurinol significantly improved skin flap survival.

Highlights

Surgeons rely on skin flaps to reconstruct tissue defects resulting from trauma, ablative surgery or congenital malformation
Comparison of two types of skin flaps showed that mean total area of the necrotic zone in allopurinol treated skin flaps (27.6 Cm2) have been significantly less than necrotic area in normal flaps (78 Cm2) over all 7 days of observation [Figure 2]
Dogs in the control group presented an average of 81.25% of necrosis in the flap total area; those which received allopurinol presented an average of 28.75% of necrosis

Summary

Introduction

Surgeons rely on skin flaps to reconstruct tissue defects resulting from trauma, ablative surgery or congenital malformation. Howeer, prolonged tissue ischemia in setting of trauma or prolonged procedures can lead to tissue necrosis and eventual demise of the skin flap [1, 2]. Ischemia-reperfusion (IR) injury is one of the most important causes of flap damage. IR injury likely results in a complex pathway involving neutrophil infiltration and production of superoxide free radicals which lead to irreversible tissue damage, need for reoperations, prolonged hospitalization and increased medical costs [10,11,12,13,14]. This study was undertaken to evaluate whether steady state concentrations of allopurinol can improve ischemia in canine skin flaps

Methods

Results

Conclusion