Effects of tranexamic acid, salicylic acid and verapamil on ischemia reperfusioninjury in epigastric flaps in rats

One of the main pathophysiologic mechanisms of flap loss is ischemia, which develops as a result of insufficient blood supply to the flap tissue, followed by damage during reperfusion. Ischemia begins when oxygen and nutrients cannot reach the tissues due to insufficient blood supply. In this process, at the cellular level, aerobic respiration is replaced by anaerobic respiration due to lack of oxygen. This results in a chain of events including lactate accumulation, a decrease in intracellular pH and dysfunction of ion pumps in the cell membrane. ATP stores available for energy production are rapidly depleted and cellular damage begins. In this study, pharmacological solutions to the problems encountered by flaps, which are frequently used in plastic and reconstructive surgery applications, when exposed to ischemia reperfusion injury were investigated. Using a rat epigastric flap model, the effects of tranexamic acid, salicylic acid and verapamil in preventing ischemia reperfusion-induced tissue damage were evaluated. The study was planned as a controlled randomized animal experiment and a total of 40 Wistar-Albino rats were used in the main experiment. In the experiment, rats were divided into five groups: Control group, surgical delay group (delay), tranexamic acid (TXA) group, salicylic acid (ASA) group and verapamil (VP) group. Epigastric flaps of rats were surgically prepared and exposed to ischemia for 7 hours. Before the onset of reperfusion after ischemia, pharmacologic agents were administered to the respective groups, and then the flaps were sutured in place primerally. The evaluation was performed by macroscopic observations and the results were evaluated by statistical analysis. Necrosis rates were determined by pixel based measurements with ImageJ and Adobe Photoshop programs. As a result of the study, surgical delay and salicylic acid were found to be significantly effective in preventing ischemia reperfusion injury and increasing flap survival. Verapamil and tranexamic acid also had favorable effects; however, these effects were more limited compared to salicylic acid. The results suggest that pharmacological interventions may be an effective approach to reduce ischemia reperfusion injury. In this context, it is suggested that tranexamic acid, verapamil and salicylic acid should be considered as potential agents in treatment strategies to improve flap survival in plastic and reconstructive surgery. Furthermore, the favorable effects of surgical delay technique on flap survival support the idea that the use of pharmacologic agents may provide a synergistic benefit.