Combination Therapy for Salvaging a Failing Experimental Skin Flap

Abstract

The failing free flap remains a major problem for the reconstructive surgeon. Many and varied pharmacologic agents have been utilized to reverse the effects of ischemia in these flaps. Treatments have been aimed at inhibiting presumed causative factors in the no-reflow phenomenon. Therapy has generally been single in nature and designed to affect only one of these presumed factors. In this study, several pharmacologic agents were utilized individually or in combination therapy as postischemic washouts, in an effort to attack the multiple causative factors in the no-reflow phenomenon and to improve flap survival in a rat abdominal skin flap model. The treatment agents included lactated Ringer's, superoxide dismutase, and urokinase, with each used independently as a postischemic perfusion washout. Combination therapy utilized an initial postischemic perfusion with urokinase, followed by a second perfusion washout with superoxide dismutase. After 18 hr of primary ischemia, there was increased flap survival in the animals undergoing perfusion washout with either superoxide dismutase alone or with combined urokinase and superoxide dismutase washouts, compared to all other treatments (p < 0.001). It was found that flaps undergoing combined urokinase and superoxide dismutase postischemic perfusion washouts demonstrated significantly improved survival after 20 hr of primary ischemia, compared to all other therapies (p < 0.05). By demonstrating improved survival when a thrombolytic agent is used in conjunction with an oxygen free radical scavenger, these findings may have implications in the treatment of clinically failing free flaps.

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

“…Occurrence of necrosis may be attributed to the metabolic, anatomic, and haemodynamic changes in the flap [1][2][3]. Numerous experimental and clinical studies have been performed to improve flap viability by alternating the pathological changes in flap metabolism occurring after elevation [4][5][6][7][8][9][10][11]. Phosphodiesterase type 5 (PDE5) is an enzyme that is responsible for the degradation of cyclic 3',5'-guanosine monophosphate (cGMP).…”

Diyabetik ve diyabetik olmayan sıçanlarda flep yaşayabilirliğine “Rosiglitazon”un etkisinin araştırılması

“…Geçmiş çalışmalar çeşitli antioksidan ve antiinflamatuvar ilaçların flep yaşaya-bilirliği üzerine olumlu etkilerini gös-termiştir (25)(26)(27)(28)(29)(30). Bu çalışmaların yanında Emekli ve ark.…”

Fail-Safe Drainage Procedure in Free Radial Forearm Flap Transfer

“…11,12 Since venous thrombosis is presently not completely prevent-able, attempts have been made to develop strategies to salvage the flap by early detection of postoperative thrombosis, such as by postoperative flap monitoring 11,22,23 and other salvaging methods. 24,25 Once vascular thrombosis occurs, however, the viability of the flap is often impaired, resulting in delayed wound healing, even when the flap is salvaged by re-anastomosing. In head and neck reconstruction, delayed wound healing often results in oropharyngocutaneous fistulas and in the exposure of large neck vessels.…”