Changes in arterial blood flow of free flaps after the administration of sildenafil in swine

Abstract

We evaluated blood flow changes after experimental free tissue transfer and the potential hemodynamic effect of sildenafil on the free flap. Sixteen swine were used for free transfer of a latissimus dorsi myocutaneous flap to the chest that was anastomosed to the internal mammary vessels, and were randomized into controls and study group. The latter received a single dose of sildenafil, 6 hours following flap revascularization. Doppler ultrasonography revealed that arterial flow was mainly systolic postoperatively. Diastolic flow patterns were gradually restored after the first postoperative day. Pulsatility index (PI) significantly increased and flow volume decreased in all animals postoperatively. In the sildenafil group, PI significantly decreased and flow volume increased, while diastolic flow patterns were restored earlier on compared to controls, postoperatively. In conclusion, the administration of sildenafil after free tissue transfer increases flow volume and facilitates the restoration of diastolic blood flow patterns in the early critical postoperative period. © 2011 Wiley‐Liss, Inc. Microsurgery 2011.

Comparison of the effects of systemic sildenafil, tadalafil, and vardenafil treatments on skin flap survival in rats

“…Vasodilator properties of PDE5 inhibitors and their inhibitory effects on thrombus forming capabilities of platelets are known [14][15][16]. Considering these properties, many experimental studies have been conducted to investigate the effects of PDE5 inhibitors on flap survival [17][18][19][20][21].…”

“…Gravvanis et al [15] conducted an experimental study in swine and demonstrated an increase in flow volume and a facilitated restoration of diastolic blood flow patterns in the early postoperative period by sildenafil administration after free tissue transfer. In the present study, flap blood flow was monitored by Doppler flowmetry and significant changes were observed in flap blood flow between Day 0 and Day 7 in the drug-free control group; however, PDE5 inhibitors preserved the blood flow balance.…”

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

“…[75][76][77][78][79][80][81][82][83][84] However, clinical data remain limited. In a double-blind, randomized, controlled trial, systemic milrinone did not improve flap outcomes.…”

Markers of blood coagulation and fibrinolysis in patients with early and delayed microsurgical reconstructions in the lower extremities

“…Especially the effect of haemodilution has been reported contradictory with groups describing a significant increase in flap loss [34][35][36][37][38][39]. As one of the more recent approaches, Sildenafil (Viagra V R ) has been shown to postoperatively increase the bloodflow in free LD transfers in one experimental animal study [40]. Finally, flap loss is attributed to a multitude of colliding factors at the same time and eventually on the background of insufficient microsurgery or surgical planning in some instances.…”