The effect of subcutaneous application of thrombolytic, anticoagulant and vasodilalator medications to random pattern skin flap survival

Skin flaps are the most common applications in reconstructive surgery.Various medications are used to improve flap survival.Caudally based dorsal flap model was applied to 24 rats in 4 groups. InGroup 1 (n=6) flap was elevated and sutured. In Group 2 (n=6) Clexane wasinjected subcutaneously right after surgery at day 1 and day 2 postoperativerespectively. In Group 3 (n=6) Nitroderm patch was applied right after surgery,day 1 and day 2 postoperatively. In Group 4 (n=6) Actilyse was injectedsubcutaneously right after surgery, day 1 and day 2 postoperatively.Blood flow was measured with laser doppler flowmetry from the proximaland distal halves of flap, four times, such as before surgery, right after surgery,day 3 and day 7 postoperatively. Histologic samples were taken from proximaland distal halves at day 3 and day 7 postoperatively. Photographs were taken todetermine flap necrosis areas at day 7 postoperatively.Skin necrosis area was found less than control group in the medicationgroups, but only in Clexane group skin necrosis was significant statistically(p<0,05). Laser doppler flowmetry results showed gradual decrease in all groupswith time, but results was not significant statistically. Histologic findings revealedinduction of angiogenesis in all medication groups but Nitroderm group was moreprominent. In conclusion medications which have systemic usage could bebeneficial in improving flap survival when used subcutaneously.