Kourosh Ghanbarzadeh1, Omid Reza Tabatabaie2, Ebrahim Salehifar3, Massoud Amanlou4, Ghasemali Khorasani1. 1. Division of Plastic and Reconstructive Surgery, Imam Khomeini Hospital Complex, Tehran, Iran. 2. Tehran University of Medical Sciences, Tehran, Iran. 3. Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran. 4. Department of Medical Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND: A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. OBJECTIVE: To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. METHODS: The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. RESULTS: BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). CONCLUSIONS: BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
BACKGROUND: A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. OBJECTIVE: To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. METHODS: The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. RESULTS: BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). CONCLUSIONS: BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
Entities:
Keywords:
Botulinum toxin type A; Flap; Nitroglycerin; Rat; Skin flap
Authors: Dennis F Schweizer; Riccardo Schweizer; Shengye Zhang; Pranitha Kamat; Claudio Contaldo; Robert Rieben; Daniel Eberli; Pietro Giovanoli; Dominique Erni; Jan A Plock Journal: J Surg Res Date: 2013-04-24 Impact factor: 2.192
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