Nicotine on rat TRAM flap

Abstract

Purpose:The transverse rectus abdominis myocutaneous (TRAM) flap is one of the preferential techniques used in breast reconstruction following mastectomy. Nicotine has a detrimental effect on cutaneous flap survival; although there are no experimental studies proving this effect on musculocutaneous flaps. The aim of this study is to verify the effect of nicotine on the rat TRAM flap. Methods: 30 Wistar EPM-1 rats were randomly distributed in two groups: control and experimental. The animals of the control group received saline solution injected subcutaneously, in a volume of 0.2 ml, twice a day, during 28 days in the preoperative period. The animals of the experimental group were treated with nicotine, injected subcutaneously, in a dose of 2 mg/kg twice a day, during 28 days in the preoperative period. All the animals were submitted to the caudally based, right unipedicled TRAM flap. 48 hours after the procedure, a study of the viable area of the flap was done through photographic documentation. Statistical analysis was performed with nonparametric Mann-Whitney's test. Results: The experimental group had significantly greater area of necrosis when compared with the control group (p<0.001). Conclusion: Nicotine increased the area of necrosis of the TRAM flap, in rats. Key words: Surgical Flaps. Nicotine. Rectus Abdominis. Surgery, Plastic. Rats. RESUMOObjetivos: O retalho musculocutâneo transverso do músculo reto do abdome (TRAM) é uma das principais opções na reconstrução do relevo mamário pós-mastectomia. A nicotina tem efeito deletério na viabilidade de retalhos cutâneos; porém, não foram encontrados trabalhos experimentais comprovando este efeito em retalhos musculocutâneos. O objetivo deste trabalho é investigar o efeito da nicotina na viabilidade do retalho TRAM, em ratos. Métodos: Foram utilizados 30 ratos da linhagem Wistar EPM-1. Os animais foram distribuídos aleatoriamente em dois grupos: controle e experimento. Os animais do grupo controle foram tratados com solução salina injetada no tecido celular subcutâneo num volume de 0,2 ml, duas vezes ao dia, durante 28 dias no período pré-operatório. Os animais do grupo experimento foram tratados com nicotina injetada no tecido celular subcutâneo em uma dose de 2mg/kg/2 vezes ao dia, durante 28 dias no período pré-operatório. Todos os animais foram submetidos ao procedimento do retalho TRAM de base caudal unilateral à direita (pedículo não dominante). 48 horas depois, foi feita a avaliação da área viável de superfície do retalho, por documentação fotográfica. Para análise dos resultados foram utilizados testes não paramétricos: Mann-Whitney. Resultados: O grupo experimento apresentou uma área de necrose maior, quando comparado com o grupo controle (p<0,001). Conclusão: A nicotina aumentou a área de necrose do retalho TRAM, em ratos.

Analysis of effect isoxsuprine hydrochloride and nicotine in the Transverse Rectus Abdominis Myocutaneous flap (TRAM) in rats

“…Nicotine has detrimental effects on the viability of skin flaps and there are few studies showing its effects in musculocutaneous flaps 8 . The isoxsuprine hydrochloride produces peripheral vasodilation by a direct effect on vascular smooth muscle, primarily within skeletal muscle, with little effect on cutaneous blood flow [9][10][11][12][13] .…”

Histology of the rectus abdominis muscle in rats subjected to cranial and caudal devascularization

“…This complication occurs due to tension in the vascular pedicle, hematomas and technical errors. Among the patients that presented complications, 32% had previously been subjected to radiotherapy and 26% were smokers [3][4][5] .…”

A Second Look at Nicotine Replacement Therapy Before Surgical Procedures

“…Preclinical animal studies suggest that nicotine can impair bone healing and metabolism, 5 decrease mechanical strength of healing fractures, 6 adversely impact osseointegration of titanium implants, 7 contribute to flap ischemia and necrosis, 8 and reduce anastomotic patency in blood vessels. 9 Intriguingly, a contradictory study suggested that nicotine aids in wound healing.…”