Comparison of Prostaglandin E1 and Sildenafil Citrate Administration on Skin Flap Survival in Rats

Choi, Ji An; Lee, Keun Cheol; Kim, Min Su; Kim, Seok Kwun

doi:10.7181/acfs.2015.16.2.73

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…Histological findings related to rats of the control group in the present study revealed the same results of Ayyildiz et al 11 , Choi et al 19 , and Rech et al 20 who showed that the main pathological changes in the skin flap are epidermal exfoliation, widespread neutrophil leukocyte infiltration, increased granulation tissue, increased inflammation, necrosis, and fibroblastic reaction ( Supplementary Fig. 3A).…”

Section: Discussionsupporting

confidence: 90%

“…8). Choi et al 19 showed the same ameliorative effect of sildenafil according to their histological findings.…”

Section: Discussionmentioning

confidence: 70%

“…Group III (sildenafil group): rats received oral sildenafil treatment for 7 days after the flap operation in addition to daily SC nicotine injections locally at the base of the future flap for 40 days before and 7 days after the random-pattern skin flap surgery 19 .…”

Section: Methodsmentioning

confidence: 99%

“…Sildenafil 100 mg tablets (Viagra, Pfizer Labs, NY, USA) were ground and mixed with a volume of 10 mL saline solution to obtain a simple syrup with a final concentration of 2.5 mg/mL, which was then stored in opaque bottles until use. Sildenafil was given by oral gavage through a flexible gastric tube at a dose of 20 mg/kg/day for 7 days starting from the day of operation until sacrifice 19 .…”

Section: Methodsmentioning

confidence: 99%

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The Effects of Sildenafil and/or Nitroglycerin on Random-pattern Skin Flaps After Nicotine Application in Rats

Ellabban

Fattah

Kader

et al. 2020

Sci Rep

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Smoking aggravates skin necrosis as a complication of random-pattern flap ischaemia. Sildenafil and nitroglycerin (NTG) are vasodilator agents that may affect skin flap survival. Fifty rats were subjected to a dorsal random-pattern flap operation and randomly divided into 5 groups. The control group received no treatment. The ischaemic group were administered local nicotine injections. The sildenafil group were administered oral sildenafil treatment in addition to the same intervention as the ischaemic group. The NTG group received topical NTG ointment application instead of sildenafil. The combined group were given both sildenafil and NTG treatments. After 7 days, all rats were sacrificed for flap assessment. Flap survival percentages at the 3 rd and 7 th days were significantly higher in the combined group than in the other study groups. Histologically, the ischaemic group exhibited dermal disorganization and inflammatory cell infiltration, which were improved in the 3 treated groups; however, the combined group presented the most relevant effect. The epidermal thickness showed a decrease in the ischaemic group (23.1 μm) that was significantly increased in the sildenafil (28.4 μm), NTG (28.8 μm) and combined (35.8 μm) groups. Immunohistochemically, the combined group exhibited a significant decrease in the apoptotic index and an increase in the proliferative index (2.3 and 56.9%, respectively) compared to those in the ischaemic (63.2 and 3%), sildenafil (41.7 and 28.1%) and NTG (39.3 and 30.4%) groups. Transmission electron microscopy (TEM) showed that the combined group displayed improvement in most of the ischaemic changes. Our analyses suggest that the combined use of sildenafil and NTG is more efficacious than using only one of these treatments for skin flap survival.Random skin flaps are widely used options for the reconstruction of large acquired or congenital skin defects 1 . Survival of these flaps is highly reliant on oxygen delivery to their tissues 2 . The main challenge is that the distal parts of the flap suffer from a reduced blood supply, which can trigger skin necrosis 3 . This reduction in the blood supply is mainly caused by anatomical or haemodynamic factors 4 . During vascular regeneration, ischaemia/reperfusion injury occurs, promoting oxidative stress and apoptosis 3 . Additionally, other factors, such as inadequate angiogenesis and inflammatory reactions, play roles in the pathogenesis of flap necrosis 5 .Skin flap ischaemic necrosis and increased incidence of infection can be aggravated by nicotine, which endangers the results of plastic skin reconstruction 6 . Smoking increases the risk of skin flap complications, which has been observed in clinical and experimental studies in both rats and hamsters 7 . Smokers have a higher risk of developing skin flap necrosis, namely, 13 times higher than that of non-smokers, which can result in flap loss or secondary contractures that negatively affect the aesthetic outcomes 6,8 . The potential mechanisms of this increased risk in smokers are highly...

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Section: Discussionsupporting

confidence: 90%

“…8). Choi et al 19 showed the same ameliorative effect of sildenafil according to their histological findings.…”

Section: Discussionmentioning

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The Effects of Sildenafil and/or Nitroglycerin on Random-pattern Skin Flaps After Nicotine Application in Rats

Ellabban

Fattah

Kader

et al. 2020

Sci Rep

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“…Its use in breast surgery is gaining more popularity and it has been shown to reduce mastectomy skin flap necrosis [15]. Application of nitroglycerin ointment or intravenous administration of prostaglandin can promote venous drainage through vasodilation [5,16]. If all methods fail and partial or complete necrosis of the NAC is inevitable, healing by secondary intention may also be used with satisfactory outcomes depending on the patient [17].…”

Section: Discussionmentioning

confidence: 99%

Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Park

Myung

2021

Arch Aesthetic Plast Surg

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Reduction mammoplasty is a popular operation worldwide. Early complications include bleeding, wound dehiscence, and nipple-areolar complex (NAC) ischemia. Although uncommon, NAC ischemia can lead to necrosis of the NAC. NAC congestion is usually recognized intraoperatively or within a few hours of the operation. A 21-yearold woman with severe macromastia received bilateral reduction mammoplasty using a Wise-pattern reduction with a superomedial pedicle. NAC congestion of the left breast was identified 40 hours after the operation. Delayed venous congestion of the NAC after reduction mammoplasty has not been previously reported; in this case, delayed congestion may have been caused by partial venous obstruction aggravated by the progression of tissue edema near the pedicle. Through use of the delayed suture technique, application of nitroglycerin cream, intravenous administration of prostaglandin E1, and use of a portable negative-pressure wound therapy device, the patient's NAC was salvaged with satisfactory nipple projection and minimal scarring.

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Clinical effectiveness of postoperative prostaglandin E1 administration in reducing flap necrosis following microsurgical reconstruction

Park,

Lee

2024

Microsurgery

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BackgroundExtensive experimental evidence has suggested the potential efficacy of prostaglandin E1 (PGE1) in enhancing flap survival, leading to its widespread empirical use following free flap operation. However, the translation of these experimental findings into clinical benefits remains uncertain. This study aimed to assess the clinical effectiveness of postoperative PGE1 administration on the outcomes of microsurgical reconstruction.MethodsA retrospective review was conducted for patients who underwent free flap‐based reconstruction between September 2020 and November 2022, dividing into two cohorts. For all consecutive cases conducted during the formal half, PGE1 was administered for postoperative 7 days (PGE1 cohort), and for those during the latter, PGE1 was not given (non‐PGE1 cohort). The profiles of perfusion‐related complications (PRC) were compared between the two cohorts. Further analyses after propensity‐score matching were performed.ResultsIn total, 274 cases were analyzed, consisting of 142 in PGE1 and 132 in non‐PGE1 cohort. Baseline characteristics were similar between the two cohorts, except for higher rates of comorbidities and chronic wound‐related defects in the PGE1 cohort. Overall PRC developed in 37 cases (13.5%), including 6 (2.1%) total loss and 38 (10.2%) partial necrosis. Compared to the control, the PGE1 cohort exhibited significantly lower rates of overall PRC and partial flap necrosis. This difference remained significant on multivariable analyses. The rate of total flap loss did not differ between the cohorts. Consistent associations were observed in the propensity‐score matching analysis.ConclusionPostoperative administration of PGE1 appears to be associated with reduced risks for the development of partial flap necrosis.

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Comparison of Prostaglandin E1 and Sildenafil Citrate Administration on Skin Flap Survival in Rats

Cited by 10 publications

References 11 publications

The Effects of Sildenafil and/or Nitroglycerin on Random-pattern Skin Flaps After Nicotine Application in Rats

The Effects of Sildenafil and/or Nitroglycerin on Random-pattern Skin Flaps After Nicotine Application in Rats

Treatment of delayed venous congestion of the nipple-areolar complex after reduction mammoplasty

Clinical effectiveness of postoperative prostaglandin E1 administration in reducing flap necrosis following microsurgical reconstruction

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