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Published on: June 8, 2013
Tranexamic Acid Concentration and Flap Survival in Rats
Ertuğrul Karanfil1, Metin Görgü1, Berkalp Berker1
1Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Abant İzzet Baysal University, Gölköy Campus, Bolu, Turkey.
Background:
Random-pattern skin flaps are prone to distal necrosis, a major challenge in reconstructive surgery. Tranexamic acid (TXA) reduces perioperative bleeding, but its impact on flap viability remains controversial.
Objectives:
To investigate the concentration-dependent effects of local TXA application on random-pattern flap survival, with and without surgical delay, in the McFarlane dorsal rat flap model.
Methods:
Sixty-four female Wistar albino rats were randomized into eight groups (n=8): control, TXA 10, 30, and 100 mg/mL, delayed control, and delayed TXA at the same concentrations. A 3×9 cm caudal-based dorsal flap was elevated and 1 mL of saline or TXA was administered locally before closure. Flap necrosis was quantified using ImageJ software. Two-way ANOVA assessed the independent effects of delay and TXA concentration; subgroup analyses used one-way ANOVA with Tukey HSD (non-delayed) and Kruskal-Wallis with Dunn's test (delayed).
Results:
High-concentration TXA (100 mg/mL) significantly increased necrosis in non-delayed flaps (40.39% ± 7.41%, p = 0.016 vs. control). Delayed flaps showed markedly reduced necrosis across all groups (delayed control: 1.00% ± 1.45%, p < 0.001). No significant differences were observed among delayed subgroups regardless of TXA concentration. Two-way ANOVA identified the delay procedure as the dominant main effect (F(1,56) = 665.97, p < 0.001, partial η2 = 0.922).
Conclusions:
High-concentration local TXA impairs random-pattern flap survival, while low-concentration TXA (10 mg/mL) appears well tolerated. The surgical delay procedure markedly reduces TXA-associated necrosis risk across all concentrations. Careful concentration selection is recommended when TXA is used in cutaneous flap surgery.
