Abstract
The effects of antithrombotic drugs on random and free flap survival have been investigated in the past, but the experimental and clinical results are not in agreement. A perforator-based critical ischaemia model was used to evaluate the effects of different perioperatively administered pharmaceutical agents on tissue ischaemia and to assess the potential additional haemorheological or vasodilative effects of antithrombotics on flap microcirculation. Combined laser Doppler flowmetry and remission spectroscopy revealed an increase in certain microcirculation parameters in most groups in comparison with saline controls, and these changes correlated with flap survival. Clopidogrel and hirudin significantly improved the amount of viable flap tissue in comparison with controls, while unfractioned heparin had a negative effect on flap survival. Low molecular weight heparin, aspirin, pentoxifylline, and hydroxyethyl starch had no impact on the amount of viable flap tissue. A higher complication rate was observed in all experimental groups, but only clopidogrel had a negative impact on the flap viability. Our results add to the body of evidence supporting the conclusion that perioperative antithrombotic treatment improves flap survival. Clopidogrel and hirudin are effective pharmacological agents that significantly increased the viability of perforator-based skin flaps in rats, but at a higher risk of postoperative bleeding.
Highlights
Apart from the well-studied antithrombotic effects, additional anti-inflammatory[4], vasodilative[28,29] and/or haemorheological effects[5] have been assumed for numerous antithrombotic agents such as acetylsalicylic acid, heparin and clopidogrel
The microcirculation parameters tended to recover in most groups with the exception of the groups administered saline solution, unfractioned heparin, low molecular weight heparin and Hydroxyethyl starch (HES)
The oxygen saturation tended to recover in the groups treated with clopidogrel, unfractioned heparin, pentoxifylline and HES, but did not reach the base values in any of the groups
Summary
Apart from the well-studied antithrombotic effects, additional anti-inflammatory[4], vasodilative[28,29] and/or haemorheological effects[5] have been assumed for numerous antithrombotic agents such as acetylsalicylic acid, heparin and clopidogrel. Instead of limiting the focus of our study to the vessel patency[6,7,9,10,11,14,30,31,32,33,34], another advantage of the surgical model used in this study was that it was possible to monitor the microcirculation changes in the skin and assess the actual clinical outcome (flap vitality), thereby further assessing possible additional drug effects
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