Supplementation of high-dose ascorbic acid reduces necrosis on random dorsal skin flap in rats

Abstract

Background: Flap necrosis due to ischemia-reperfusion injury remains a challenge to minimize in every flap procedure. Antioxidants are one of the alternatives developed to reduce free radicals formed from ischemia-reperfusion injury after the severance of blood vessels while also accelerating the wound healing process. Ascorbic acid (vitamin C) is the most widespread antioxidant available worldwide. Objective: To determine the effect of high-dose ascorbic acid in reducing the occurrence of necrosis on random dorsal skin flaps in Wistar rats. Methods: An double-blinded in-vivo experimental study was done on 36 Wistar rats undergoing a random dorsal skin flap procedure. The samples were divided into 2 groups. The intervention group samples were injected with high-dose ascorbic acid injection intraperitoneally at 300mg/kgBW per day for up to 7 days, while the control group samples were injected with normal saline. Variables analyzed were macrophage and malondialdehyde amount on the third day, fibroblasts amount on the seventh day, and distal flap necrosis on the seventh day. Result: Higher macrophage (14.56 vs. 4.78, p < 0.001) and fibroblasts amount (54 vs. 18, p < 0.001) were observed on the intervention group. Lower malondialdehyde amount (12 vs. 28, p < 0.001) was observed in the intervention group. There was a lower percentage of distal flap necrosis in the intervention group (11.9 vs. 36.2%, p < 0.001). Conclusion: Intraperitoneal injection of high-dose ascorbic acid reduced the extent of distal flap necrosis on random dorsal skin flaps of Wistar rats. Highlights