Z. Wu3, M. M. Ibrahim1, R. Schweller2, B. Phillips1, B. Klitzman1,2,3 1Duke University Medical Center,Division Of Plastic, Maxillofacial And Reconstructive Surgery,Durham, NC, USA 2Duke University Medical Center,Biomedical Engineering,Durham, NC, USA 3Duke University Medical Center,School Of Medicine,Durham, NC, USA
Introduction: 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 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 performed for analysis.
Results:Pharmacologic delay with preoperative application of topical minoxidil and 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 a topical vehicle. Pharmacologic delay was found to increase blood flow during the preoperative period through vascular remodeling rather than acute vasodilation. These changes were not observed in flaps that were only treated in the postoperative period.
Conclusion:Preoperative topical application of vasodilatory agents, minoxidil and iloprost, yield equivalent viability in a random cutaneous flap model compared to the gold standard surgical delay. We have created a model of non-invasive pharmacological delay that improves tissue viability and potential postoperative complications without an additional surgical procedure.