Survival Rate Of Skin Flap Research Articles

Study on the survival rate of random flap using pre-injection of ADSCs

Objective: To determine the effects of adipose-derived stem cells (ADSCs) on the survival rate of flaps by transplanting ADSCs into the experimental flaps pre-operatively. Methods: ADSCs were isolated from fresh human fat and cultured in vitro. Their morphological characters were observed, and flowcytometry and differentiation test and evaluation were conducted. A total of 40 BALB/c mice were divided into 5 groups randomly with each of 8 mice. 1 cm×4 cm random skin flap was designed on the mice back, ADSCs were injected in advance into subcutaneous tissues of 3 groups, the operation was performed on the 2nd, 5th and 7th day after the ADSCs injection, meanwhile skin flap operation was conducted in the immediate injection group and control group. Survival condition of the skin flaps was observed and von willebrand factor (vWF) staining was used to detect the number of micro-vessels in the skin flap. The enzyme-linked immuno sorbent assay (ELISA) method was used to detect the concentration of vascular endothelial growth factor (VEGF) in the skin flap. Results: The immediate injection group had a significantly higher survival rate of skin flap than the pre-injection groups and the control group [(51.5±6.3)% vs (38.3±6.7)%, (21.0±2.9)%, (30.0±3.9)% and (34.5±4.2)%, all P<0.01]. The immediate injection group had a significantly higher number of micro-vessels in the skin flap than the pre-injection groups and the control group [(21.0±4.3) vs (17.5±3.9), (9.9±2.6), (13.9±2.6) and (16.1±3.3)/LPF, all P<0.01]. The laboratory results of the concentration of VEGF in skin flap kept a consistent tendency with the flap survival rate. Conclusion: Pre-injection with the ADSCs into the skin flap prevents the survival of the flap to a certain extend and does not show the function of promoting tissue angiogenesis.

Two-dimensional electrospun nanofibrous membranes for promoting random skin flap survival

Electrospun fibrous membranes made of natural materials are more advantageous for random skin flap survival, and can be used as carrier implantation materials for improving skin flap survival rate.

Application of exposed therapy in wound nursing after the skin flap transplantation for lower extremity injury

Objective To explore the effect of exposed therapy in wound nursing after the skin flap transplantation for lower extremity injury. Methods During January and August 2012, forty three patients, who underwent skin flap transplantation for the lower extremity injuries with soft tissue defect and whose wounds were bandaged using conventional gauze bandaging therapy, enrolled as control group. From September 2012 to April 2013, forty two patients with lower extremity injuries applied the exposed therapy when wound dressings were removed during 6 to 8 hours after surgery after skin flap transplantation as intervention group. This study aimed to evaluate the effect of conventional bandage therapy and exposed therapy by conducting the comparisons on blood circulation of transplantation flap, flap survival rate, wound infection and medical cost. Results The color, swelling and filling degree of transplanted flap in the intervention group were better than those in the control group (Z=5.63, 6.47, 6.48, respectively; P<0.01). The rate of flap normal temperature and flap survival rate were 83.33% and 97.62% in the intervention group, higher than those in the control group (χ2=7.40, 5.91, respectively; P<0.05). The wound infection rate was lower in the intervention group than that in the control group (Z=5.29; P<0.01). The data of intervention group were lower than those in the control group at medical cost, hospitalized days, switching medicine times and length of nursing (t=2.44, 32.78, 22.44, respectively; P<0.05). Conclusions For patients with skin flap transplantation, exposed therapy can effectively reduce the incidence of wound infection, and facilitate the direct observation of the flap blood circulation and the early detection of vascular crisis, so as to adopt the effective measures to prevent vascular crisis and improve the survival rate of skin flap. Key words: Skin flap transplantation; Wound nursing; Exposed therapy; Flap vascular crisis

Transplantation of adipose tissue-derived stromal cells promotes the survival of venous-congested skin flaps in rabbit ear.

Venous congestion after skin flap transplantation usually slows blood flow velocity and induces skin flap necrosis and surgical failure. Adipose tissue-derived stromal cells (ADSCs) can promote neovascularization and have been extensively applied in cell transplantation therapy and tissue regeneration. However, their function has not been reported in venous-congested skin flaps. In this study, rabbit ADSCs were isolated and identified. We established a rabbit ear venous-congested skin flap model and injected ADSCs into points along the midlines of skin flaps. The survival conditions of venous-congested skin flaps on postoperative day 7 showed that there was obvious swelling, hemorrhage, or necrosis in skin flaps of the control group, while the skin flap survival rate in the ADSC treatment group significantly increased. Hematoxylin and eosin (HE) staining results indicated that compared with the control group, thrombosis was significantly relieved and neovascularization was observed in the ADSC treatment group. Immunofluorescence revealed that the CD34 expression level and the number of capillaries significantly increased in the ADSC treatment group. In summary, ADSC transplantation promotes neovascularization in venous-congested skin flaps and skin flap survival. Therefore, ADSC transplantation may be an effective measure for promoting the survival of venous-congested skin flaps.

Metformin improves skin flap survival through nitric oxide system

BackgroundMetformin has shown cardioprotective effects in experimental models of ischemia reperfusion, which is partially mediated through nitric oxide (NO) synthesis. We investigated the effects of metformin pretreatment in a rat model of random-pattern skin flap, and the probable role of NO system. Materials and methodsIn the first experiment, the rats received increasing doses of metformin (150, 200, and 300 mg/kg), 4 h before the procedure. Dorsal skin flaps with caudal pedicles were elevated at the midline and flap survival was measured 7 d after surgery. Pathologic review of the skin flap specimen was performed in a subset of animals. In the second experiment, for evaluation of the role of NO, an NO synthase inhibitor N-nitro-L-arginine methyl ester hydrochloride (L-NAME) was administered with and without the effective dose of metformin. In the next experiment, subtherapeutic dose of NO precursor, L-Arginine, was administered with and without subeffective dose of metformin. ResultsMetformin pretreatment at doses of 200 and 300 mg/kg significantly increased skin flap survival rate. However, administration of L-NAME abolished the protective effects of metformin. On the other hand, subtherapeutic dose of L-arginine augmented the effects of low-dose metformin and significantly increased skin flap survival. Skin flaps from those rats that received 300 mg/kg metformin pretreatment and those treated with subtherapeutic doses of L-arginine and metformin showed increased vasodilation compared with control group. ConclusionsMetformin pretreatment can improve skin flap survival through an NO dependent pathway.

The effect of autologous endothelial progenitor cell transplantation combined with extracorporeal shock-wave therapy on ischemic skin flaps in rats

BackgroundEndothelial progenitor cells (EPCs) have been used to revascularize ischemic tissues, but only limited effect can be achieved. Extracorporeal shock-wave therapy (ESWT) is a promising angiogenic strategy. We hypothesized that EPC transplantation combined with ESWT would greatly benefit the survival of ischemic skin flaps. MethodsSixty-four male Sprague-Dawley rats were divided into 4 groups (n = 16 in each group): group 1 (serving as sham control), group 2 (treated with subcutaneous EPC implantation, 1.0 × 106 cells), group 3 (treated with ESWT, 300 impulses at 0.10 mJ/mm2) and group 4 (treated with EPCs implantation combined with ESWT). Ischemic skin flaps were made on the backs of rats and treated accordingly. Blood flow of skin flaps was measured periodically after operation, and flap survival rates were compared. Tissue samples were harvested at 2 weeks postoperatively from each group. ResultsThe survival rate of skin flaps in group 4 was 87.5 ± 10.23%, which was statistically significantly higher than other groups. Histologic examination showed that the capillary density was higher in the dual-treatment group than in the two single-treatment groups. Compared with groups 2 and 3, blood perfusion increased significantly in group 4. A drastic increase of vWF+ cells was observed in the ischemic skin flaps on immunofluorescence staining in group 4. The expressions of chemotactic factors and angiogenic factors were higher in group 4. ConclusionsCombined treatment with EPCs and ESWT is superior to either EPCs or ESWT alone in improving the survival of ischemic skin flaps in rats.

Effects of Saffloryellow on survival rate of skin flaps with ischemia-reperfusion injury in rats

Objective To investigate the effects of Saffloryellow (SY) on the flaps with ischemiareperfusion injury (IRI) in rats and the mechanism.Methods Thirty-two SD rats were used to establish IRI skin flaps along superficial epgastric artery.All rats were randomly divided into the control and experimental groups (n =16 each).SY injection [40 mg/(kg· d)] and normal saline with the same volume were injected into the abdominal cavity of rats respectively at 1 h prior to the reperfusion and the next 6 days after operation.The survival rate,pathologic changes,levels of superoxide dismutase (SOD),malondialdehyde (MDA) and polymerphonuclear leucocytes (PMN) of the flaps were analyzed.Results The contents of MDA and PMN were decreased (P ＜0.01),while the activity of SOD increased in the experimental group (P ＜ 0.01).The mean survival rate of the flaps at the 7th day after operation was (38.17 ±8.29) ％ in the control group and (66.53 ± 7.86) ％ in the experimental group (P ＜ 0.01).Conclusion SY can reduce the IRI and increase the survival rate of the flaps significantly in rats probably by inhibiting the activation of PAF and PMN,declining the blood viscosity,improving the activity of SOD,reducing the level of oxygenderived free radical and lipid peroxidation. Key words: Saffloryellow; Flap; Reperfusion injury

The influence of zi-hua burn cream on the survival of random skin flaps in rats

To observe the effect of zi-hua burn cream on the survival of skin flaps in rats, and its mechanisms. 72 Wistar rats, were randomly divided into four groups as zi-hua group(n = 18, external application of alfalfa burn cream), control group (n = 18, external application of heparin sodium cream), model group (n = 18, external application of vaseline) , negative control (n = 18, no operation). 8 cm x 2 cm random skin flaps with pedicle on the side of head were designed on the back of Wistar rats. The drug was applied on the flap surface, 2 times a day. The survival of skin flaps was observed. The change of serum superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), turner necrosis factor-alpha(TNF-alpha)and interleukin-6(IL-6)were compared at 1,2,3,7 d after operation, and histologic examination was performed. The survival rate of zi-hua group (73.58 - 10. 74)% was significantly higher than that of model group (33.40 - 16.05) %, showing a statistical difference (Q = 10.63, P <0.01). There was no significant difference between the zi-hua group and control group (71.65 +/- 11. 92) %. The level of serum SOD, NO in zi-hua group and control group was higher than that in model group, while the level of serum MDA, TNF-alpha and IL-6 was lower than that in model group(P <0.01). On 7 day after operation, skin flaps tissue edema,necrosis and inflammatory cell infiltration in zi-hua group and control group was less obvious than that in model group. There was significant proliferation of granuloma and fibroblast and formation of neonatal capillary in zi-hua group and control group. The vascular density in zi-hua group was obviously higher than that in the model group and control group(P <0. 01). Zi-hua burn cream could significantly improve the blood supply of skin flaps, increase the survival rate of skin flaps in rats. Its mechanism may be associated with the anti-free-radical-damage action, improve local microcirculation, improve the NO content, reduce the TNF-alpha and IL-6 level, reduce inflammation factor release, improve oxidative stress state, and reduce inflammation reaction.

The effect of nonpreserved human amniotic membrane on the survival of ischaemic skin flaps in rats

Random-pattern skin flaps are used widely in plastic surgery, but necrosis resulting from ischaemia in the distal sections of the flap is a serious problem. Free oxygen radicals and the accumulation of increased neutrophil granulocytes play important roles in tissue injury and may lead to partial or complete necrosis of the flap. Amniotic membrane is a biomaterial used widely in clinical settings to prevent the infiltration and activation of leucocytes. The aim of this study was to test the effects of amniotic membrane on the survival of ischaemic skin flaps in rats. A total of 32 male rats were divided randomly into four groups of eight, according to the procedure to be tested: flap-only (F), flap-amniotic membrane (FA), flap-Tegaderm(®) (FT) and flap-amniotic membrane-Tegaderm(®) (FAT). Rectangular, random-pattern, caudally based modified McFarlane skin flaps were elevated at the dorsum of the rats in all four groups. The flap-only group was also the control group; in this group, the flaps were elevated and sutured to their native position. In the FA group, after the flaps were elevated, the amniotic membrane was inserted underneath the undersurface of the flap. In the FT group, after the flaps were elevated, a piece of Tegaderm was inserted underneath the undersurface of the flap. In the FAT group, the amniotic membrane was inserted underneath the undersurface of the flap and the Tegaderm(®) was inserted in the flap donor area. The survival rate of the skin flaps was measured on day 7, and histologic assessments were performed. The survival rate of the skin flaps was significantly improved in the FA and FAT groups (67-69%, p<0.05) compared with the F and FT groups (46-48%, p<0.05). Histologic analysis showed many more blood vessels and fewer neutrophils in the FA and FAT groups than in the F and FT groups. This study showed that amniotic membrane could improve the survival rate of ischaemic skin flaps.

Effects of Buflomedil and Pentoxifylline on Hamster Skin-Flap Microcirculation: Prediction of Flap Viability Using Orthogonal Polarization Spectral Imaging

OBJECTIVEThis study investigated the effects of buflomedil and pentoxifylline, both of which are used in reconstructive surgery of hamster skin flap microcirculation, and evaluated the skin flap survival rate by orthogonal polarization spectral imaging.METHODTwenty-four adult male Syrian golden hamsters were divided into three groups: a control (C, 0.1 ml 0.9% saline), buflomedil (B, 3 mg/kg/day), and pentoxifylline group (P, 14.5 mg/kg/day). Treatments administered intraperitoneally were initiated 1 hour before skin flap preparation and continued for 7 days post-operatively at 12-hour intervals. Preparations (skin flaps) were divided into 12 fields, which were organized into six bands. Functional capillary density (FCD, in mm/mm2), distance from the skin flap base to blood flow cessation (Distwith flow, in cm), percentage of viable skin (VA, in%), and qualitative analysis of blood flow by orthogonal polarization spectral imaging were performed at 1 and 24 hours and on the seventh post-operative day.RESULTBands IV, V, and VI presented no flow independent of time. The functional capillary density group B was higher than that of groups C and P, primarily after 24 hours. All groups showed an increase in D with time but reached similar final distances (C = 2.73, B = 2.78 and P = 2.70 cm). Moreover, the percentage of viable areas remained at approximately 50%. The orthogonal polarization spectral imaging was useful to assess viability by counting fields with and without blood flow.CONCLUSIONSFunctional capillary density values were higher in the buflomedil group compared to the control and pentoxifylline groups in this model. Functional capillary density did not influence D or the percentage of VA, and the technique showed favorable potential to assess/predict the viability of skin flaps within 1 h after surgery.

Expression of the Endothelial Thrombomodulin (TM) on the Ischemic Rat Flap Model

Thrombomodulin (TM), a cell surface-expressed glycoprotein predominantly synthesized by vascular endothelial cells, is a critical cofactor for thrombin-medicated activation of protein C. TM thus has an impact on coagulation, inflammation, and fibrinolysis. In this study, we investigated expression of endothelial TM in the dorsal skin of the rat as an ischemic flap model. Twenty male Wistar rats weighing between 250 and 350 g were used in the study. Nine by 3-cm, full-thickness, caudally based random pattern dorsal skin flaps were elevated. The rats were randomized into 2 subgroups according to the evaluation time. Tissue blood flow of the skin flaps was measured 4 times (before the operation and on days 1, 3, and 7) at 1, 3, and 5 cm distal to the baseline of the skin flap. Skin flap samples including subcutaneous tissue were taken from killed rats at day 3 (n = 10) and 7 (n = 10) for histologic assessment. These samples were also taken from the midline at 1, 3, and 5 cm distal to the baseline of the skin flaps. The survival rate of the skin flaps was measured on day 7. According to the blood flow rate change, we found that there were significant differences between the 1-, 3-, and 5-cm samples throughout the experiment. The most profound change was that it was at 5 cm in which there was an initial pattern of reduced perfusion followed by cessation of perfusion. On the third day, positive immunoperoxidase staining specific for TM was detected in all the specimens of the skin biopsies taken from 1 and 3 cm. The 5-cm samples demonstrated very little evidence of necrosis and had negative immunoperoxidase staining for TM. The 1-cm samples were found to have preserved morphologic features present on days 3 and 7. The 3-cm samples showed no evidence of necrosis, though some of the capillary vessels were filled with aggregated blood cells. The vascular wall had negative peroxidase staining for endothelial TM. At 5 cm, there was clear evidence of necrosis, some found within the capillary vessels, which were filled with aggregated blood cells. These samples also had negative peroxidase staining for TM. On day 7, the survival rate of skin flaps was 45.35%. In this study, we demonstrate that tissue ischemia is an important factor, particularly in down-regulating TM transcription. TM depletion from the vascular cells and microthrombus formation occurred in the ischemic areas, playing an important role in secondary aggravation of tissue ischemia.

Effect of low molecular heparin sodium cream on the content of serum nitric oxide in random pattern skin flap: experiment with rats

To explore the mechanism of improvement of blood circulation in random pattern skin flap by low molecular heparin sodium cream. 48 Wistar rats underwent formation of random skin flap of the size of 2 cm x 8 cm on the back and then were randomly divided into 2 equal groups: experiment group with low molecular heparin sodium cream smeared on the skin flaps and control group with Vaseline smeared on the skin flaps. 24, 48, and 72 hours, and 7 days after the smearing blood samples were collected from 6 rats respectively to detect the content of serum nitric oxide a (NO). Seven days after the smearing specimens were collected from the upper, middle, and lower parts of the skin flaps to undergo pathological examination. (1) The serum NO content of the experiment group was (53 +/- 15) micromol/L, significantly higher than that of the control group [(27 +/- 20) micromol/L, P < 0.05] 7 days after the operation. (2) The skin flap survival rate of the experiment group was (66 +/- 18)%, significantly higher than that of the control group [(22 +/- 16)%, P < 0.01]. (3) Histomorphology showed formation of neo-vessels with integrated endangium of capillary, stability of structure of mitochondria, and milder cell swelling in the flaps treated with heparin cream. Low molecular heparin sodium cream increases the content of serum NO, thus increasing the survival of skin flaps.

The Effect of Fibrin on the Survival of Ischemic Skin Flaps in Rats

Skin flap necrosis is one of the hazards encountered in plastic and reconstructive surgery. Angiogenic agents may be useful for treating it by increasing blood flow. The angiogenic effect of fibrin in vitro has been demonstrated, but little is known about its in vivo effect. Te authors tested the hypothesis that local application of fibrin can improve the survival of ischemic skin flaps. A cranially based dorsal skin flap (3 x 7 cm) was made in each rat. Fibrin (8 mg suspended in 400 microl of phosphate-buffered saline) was applied to the subcutaneous side of elevated skin flaps in the experimental group (n = 15), and phosphate-buffered saline alone was delivered in the control group (n = 15). Tissue blood flow of the skin flaps was measured four times (before the operation and on days 1, 3, and 7) at 1, 3, and 5 cm distal to the baseline of the skin flap. The survival rate of the skin flaps was measured on day 7 and histologic assessments were performed. The blood flow change rate at 5 cm in the experimental group was significantly higher than that in the control group on day 7 (60.9 +/- 5.7 percent versus 13.7 +/- 4.8 percent, p < 0.001). The survival rate of skin flaps was also significantly improved in the experimental group (77.0 +/- 2.0 percent) in comparison with the control group (54.7 +/- 2.2 percent, p < 0.01). Histologic analysis showed many more blood vessels in the experimental group in comparison with the control group. The local application of fibrin could improve the blood flow and survival of ischemic skin flaps.

Improvement of survival of skin flaps by combined gene transfer of hepatocyte growth factor and prostacyclin synthase

Increasing the local blood flow is a critical factor for long-term survival of skin flaps. Thus, a molecular therapy to increase the blood flow by means of an angiogenic factor is considered to be a useful strategy to improve skin flap survival. We focused on a combined strategy to stimulate not only angiogenesis, but also vasodilation of local microvessels, using co-transfection of the hepatocyte growth factor (HGF) and prostacyclin synthase (PGIS) genes to enhance the survival of random-pattern skin flaps. A 2 x 8 cm full thickness cranial pedicled random-pattern flap was made on the back of each 12-week-old male rat. At 3 days before operation, 400 microg of human HGF and PGIS naked plasmid DNA or control plasmid was transfected into the flaps by needle-less injection using a Shima Jet, resulting in successful expression of human HGF and PGIS in the skin flaps. Transfection of both genes into the distal half of skin flaps at 3 days prior to operation significantly increased the survival rate of skin flaps, while transfection all over the flaps did not. In addition, transfection prior to operation was more effective than simultaneous treatment. Moreover, co-transfection of these genes improved the survival area of skin flaps, accompanied by an increase in blood flow of skin flaps, even in a diabetic model. Overall, these results indicate that combination treatment with HGF and PGIS genes by Shima Jet could be an effective strategy to improve skin flap survival.

Acute Remote Preconditioning Augments Random Skin Flap Survival, But Not Recipient-Bed Isolated Flaps In Rats

This study proposes that acute remote preconditioning (ARIP) can effectively enhance random skin flap survival.The study was a randomized controlled trial using male sprague-Dawley rats as subjects. For acute remote preconditioning, left hindlimb ischemia was achieved by clamping the femoral artery and vein.After 1 hour's ischemia, the limb reperfusion was done for 30 minutes. Then, a 3by 9cm dorsal caudal-based, random pattern skin flap was elevated and reaproximated for flap survival studies. Thirty rats were divided into three groups of 10 rats each. The first group had only the flap raised, while the second and third groups had acute remote preconditioning protocol before the flap elevation. In the third group, a silicone sheet was inserted beneath the flap in order to prevent neovascularisation from the bed. The amount of flap necrosis was measured on the seventh postoperative day. ARIP (acute remote ischemic preconditioning) group had the most improved skin flap survival rate, and the flap survival rates between the ARIP+silicone sheet and control groups was not statistically different (p>0.05). These findings indicate that remote ischemic precontioning enhances random skin flap survival, when it is performed just before the flap harvest and the isolation of recipient bed abolishes this ameloriating effect.

Promotion of the survival of ischemic skin flap by transplanted endothelial progenitor cells transfected with VEGF165 gene: an experimental study with mice

To investigate the feasibility of transplanted endothelial progenitor cells transfected with VEGF165 gene to ischemic flap with increased neovascularization and augmented the survival areas. EPCs were isolated from human cord blood and cultured in vitro. Plasmid PcDNA3.1(-)/VEGF165 containing VEGF gene was transfected into the EPCs. EPCs transfected with blank plasmid, and EPCs without transfection were used as controls. ELISA was used to detect the expression of VEGF protein in the culture fluids. The EPCs were dyed with CM-DiI 7 days later. Ischemic skin flaps were made on the backs of 27 nude mice. The mice were randomly divided into 3 equal groups with their skin flaps being transplanted with EPCs transfected with 3.1(-)/VEGF165 plasmid, EPCs not transfected with 3.1(-)/VEGF165 plasmid, and injected with M199 medium at the basal part. Four days after the peduncles of the skin flaps were cut. Seven days after the cutting-off of the peduncles the survival rate of skin flap was observed and the blood perfusion was observed with laser Doppler flowmetry, 10 days after the density of capillary arteries were observed with microcirculation microscope. Three specimens of skin flap were taken 7 and 11 days after the skin flaps were made to undergo histological examination to detect the density of capillary arteries by CD34 immunohistochemistry and to observe the proliferation of EPCs with fluorescence microscopy. Peripheral blood samples were collected 1, 4, 7, 14, and 28 days after the skin flaps were made to undergo ELISA to detect the levels of VEGF protein The VEGF levels in the culture supernatants of the groups A, B, and C were 352 ng/L +/- 35 ng/L, 45 ng/L +/- 5 ng/L, and 0 ng/L respectively with significant difference between any 2 groups (all P < 0.05). The skin flap survival rates of the three groups were 97.2%, 60.3%, and 34.2% respectively with significant difference between any 2 groups (all P < 0.05) and the survival quality of the group A was the best. The capillary density of the group A was greater than those of the groups B and C. The VEGF levels at any time point of the group A were all significantly higher than those of the group B and C (all P < 0.05) and there was not a significant difference between the groups B and C. The capillary density levels at different time points decreased progressively in the order of groups A, B, and C with significant difference between any 2 groups (all P < 0.05). No EPC was shown by fluorescence microscopy in the skin flaps of the group C. The EPC density in skin flap 7 and 11 days after the flaps were made were 136 +/- 10 and 75 +/- 6/mm(2) and 305 +/- 26 and 199 +/- 18/mm(2) respectively with significant differences between the groups A and B. (both P < 0.05). The EPCs from human cord blood, especially those transfected with VEGF165 gene increases the neovascularization in ischemic skin flaps and augments their survival rate.

Ciprostene and Indomethacin Partially Reverse the Mechanisms of Distal End Necrosis in the Rat Random Skin Flap

Survival of random skin flap distal end depends on hemodynamic, cellular, and coagulation mechanisms. This study was designed to evaluate whether administration of ciprostene, a stable prostaglandin I2 analogue, and indomethacin, a cyclooxygenase-hydroperoxydase enzyme inhibitor, would improve the survival rate of random skin flaps. Forty-five male rats were divided into nine groups and injected with sesame oil (control), ciprostene (20 μg/kg/day), and/or indomethacin (2 mg/kg/day). Injections were done before (pretreatment for 4 days), after (posttreatment for 6 days), and before/after (pre/posttreatment for 4 and 6 days, respectively) the elevation of random dorsal skin flaps. In the pretreatment and pre/posttreatment studies, the flap survival rate of all drug-injected groups was significantly higher than that of the control group (p < 0.02). In addition, administration of ciprostene alone yielded a trend of better flap survival rate, which, however, was not statistically significant (p < 0.12). Of interest in the posttreatment study, only the simultaneous administration of ciprostene and indomethacin significantly increased skin flap viability compared with the other groups (p < 0.02). Therefore, the results demonstrated that administration of ciprostene and indomethacin either alone or together partially reversed the pathophysiological mechanisms that cause necrosis of random skin flap distal end. These pharmacological changes significantly improved random skin flap survival rate.

Ciprostene and Indomethacin Partially Reverse the Mechanisms of Distal End Necrosis in the Rat Random Skin Flap

Survival of random skin flap distal end depends on hemodynamic, cellular, and coagulation mechanisms. This study was designed to evaluate whether administration of ciprostene, a stable prostaglandin I2 analogue, and indomethacin, a cyclooxygenase-hydroperoxydase enzyme inhibitor, would improve the survival rate of random skin flaps. Forty-five male rats were divided into nine groups and injected with sesame oil (control), ciprostene (20 micrograms/kg/day), and/or indomethacin (2 mg/kg/day). Injections were done before (pretreatment for 4 days), after (posttreatment for 6 days), and before/after (pre/posttreatment for 4 and 6 days, respectively) the elevation of random dorsal skin flaps. In the pretreatment and pre/posttreatment studies, the flap survival rate of all drug-injected groups was significantly higher than that of the control group (p less than 0.02). In addition administration of ciprostene alone yielded a trend of better flap survival rate, which, however, was not statistically significant (p less than 0.12). Of interest in the posttreatment study, only the simultaneous administration of ciprostene and indomethacin significantly increased skin flap viability compared with the other groups (p less than 0.02). Therefore, the results demonstrated that administration of ciprostene and indomethacin either alone or together partially reversed the pathophysiological mechanisms that cause necrosis of random skin flap distal end. These pharmacological changes significantly improved random skin flap survival rate.