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The effects of nicotinamide in an abdominal island pedicle skin flap were examined. A 7 x 7 cm island pedicle skin flap ligating the left inferior neurovascular pedicle was created on 50 male Sprague Dawley rats (250-275 grams) that were divided into five groups. Animals received either 0.6 cc of saline or doses of nicotinamide for 16 days (14 days preoperatively and 2 days postoperatively): 25 mg b.i.d., 50 mg b.i.d., 100 mg b.i.d. or 200 mg b.i.d. Forty-eight hours postoperatively each animal received 25 mg of Fluorescein via the tail vein. The area of necrosis was visualized and quantified and is presented as % survival. A one factor Fisher PLSD test was performed with a statistical significance of p less than 0.05 with the results as follows: saline 58.8%, 25 mg 68.6%, 50 mg 82%, 100 mg 80.8%, and 200 mg 86%. From this data it would appear that the angiogenic factor nicotinamide may increase random flap survival.

The venocutaneous fistula technique, which involves the construction of a temporary venous return bypass using a venous graft, was devised to prevent venous congestion after fingertip replantation surgery. The proximal side of the venous graft is anastomosed to a vein at the dorsum of the finger. The distal side of the graft is sutured to the skin around a punch wound on the volar side of the replanted fingertip. This procedure was applied successfully to four fingertips in two patients without any anastomosis of the proper vein or the application of bleeding wound techniques or medicinal leeches. This method provides an excellent alternative in the treatment of venous congestion.