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Topical Vasodilator Mimics Surgical Delay to Improve Cutaneous Flap Viability and Induce Vascular Remodeling
Zi Jun Wu, BS, Mohamed M. Ibrahim, MD, Ryan Schweller, PhD, Brett Phillips, MD, Bruce Klitzman, PhD.
Duke University Medical Center, Durham, NC, USA.

PURPOSE:
Surgical delay is a well-known technique that improves perfusion of random and pedicle cutaneous flaps. The aim of this study was to create a model of pharmacological-delay that would induce vascular-remodeling and decrease overall flap-necrosis.
METHODS:
A modified-caudally-based McFarlane-flap was created using a rat model. Seven groups of random flaps were created(n=8) that included application of topical Minoxidil and Iloprost for various durations beginning 2 weeks prior to flap elevation. A standard 2-week surgical-delay group was performed for a positive control. Surgical-flaps were elevated, re-inset and observed at various time points until postoperative day 7. Gross viability, histology, perfusion analysis, tissue oxygenation and vascular casting were analyzed.
RESULTS:
Pharmacologic-delay with preoperative application of topical Minoxidil or iloprost were found to have equivalent flap-viability when compared to standard surgical delay. A significant increase in viability was observed when comparing these groups to a negative control using topical vehicle alone. Pharmacologic delay was found to increase blood flow during the preoperative period through vascular remodeling. These changes were not observed in flaps that were only treated in the postoperative period.
CONCLUSION:
Preoperative topical application of vasodilators yielded equivalent increases in viability in a random cutaneous flap-model compared to standard surgical-delay. This improvement in tissue viability usingtopical vasodilators that are approved for human usemay reduce potential for postoperative complications without additional surgical procedure.


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