Nitroglycerin transcutaneous patch: boon to salvaging post-operative partial flap necrosis, simple and effective method

Abstract

Introduction: The majority of surgical complications after tissue transfer surgery (Localtransposition of the fasciocutaneous flap, Pedicle flap, Free flap or musculocutaneous flap) arerelated to vascular thrombosis, which usually occurs within 3 days of surgery. Venous congestionusually results in oedema and darkening of the skin colour. During early venous obstruction, aneedle stick will cause rapid bleeding of dark blood and arterial obstruction or spasm will causedelayed bleeding. Patients and methods: This is prospective study was carried out during theperiod from January 2018 to February 2021 at the Plastic surgery unit-Chirayu Medical College AndHospital Bhopal, India. This study included patients aged 13 to 70 years undergoing reconstructivesurgery with flaps (Fasciocutaneous Pedicle flap, Free flap, local transposition flap ormusculocutaneous flap) for the wounds at any part of the body. The NTG patch was applied over thecutaneous surface of the compromised flap and then flap insufficiency was observed. Results: Inthis study total of 50 patients with flaps reconstruction were included. Among which 34 %( 17patients) had skin changes and 66 % (33 patients) had congested bleed on needle prick. NTGpatches were applied on the flap surface at regular intervals. After 1 week follows up, the changes in82% (41) flaps were reversed back and the flap remained healthy. 18% (nine) flaps had partial andor complete necrosis. Conclusion: There was a marked reduction in partial flap necrosis in patientswho received nitroglycerin patch. The flap survival was significantly improved and prevents the re-exploration of flaps. Their application is a simple, safe, and effective way to help salvage the flaps.