Pharmacologic enhancement of composite graft survival

The use of composite grafts in facial reconstruction has been limited by a history of unpredictable survival beyond a radius of 1 cm. Numerous pharmacologic agents have been employed to improve the survival of random skin flaps but, to our knowledge, have not been studied in composite grafts. Three agents that have demonstrated efficacy in random skin flap survival, intravenous heparin sodium, topical nitroglycerin, and intramuscular methylprednisolone sodium succinate, were investigated for their effect on composite graft survival. Using a rabbit model, full-thickness auricular composite grafts were created, rotated 180 degrees, and reattached. At 21 days, all grafts were assessed for area of survival and postexcisional weight. Animals receiving 30 mg/kg of intramuscular methylprednisolone sodium succinate daily, during the first four postoperative days, demonstrated a significant increase in graft survival compared with controls. Heparin and nitroglycerin produced no change compared with controls. Furthermore, the only grafts to achieve 100% survival were found in the group treated with methylprednisolone.