Reducing ischemia-reperfusion injury in rat island groin flaps using dexamethasone

Reducing reperfusion injury is effective in reducing flap loss after prolonged ischemia. Anti-inflammatory therapy reduces reperfusion injury in canine cardiac muscle and ex vivo rat cremaster muscle; however, to date, there are no studies involving the use of anti-inflammatory agents in ischemic skin flaps. This study was designed to assess the effects of dexamethasone and indomethacin on the viability of rat island groin flaps subjected to 10 hours of ischemia. The ischemic control and the treatment group flaps were subjected to 10 hours of ischemia by clamping the inferior epigastric vascular pedicle. The treatment groups received either intravenous dexamethasone or intravenous indomethacin after the flap vascular pedicles were clamped. Our results showed significant improvement (p < 0.05, Fisher's exact test) in ischemic flap survival using dexamethasone. The specific mode of action of dexamethasone was not investigated; however, its anti-inflammatory effects were most likely responsible for the improvement of flap survival by suppressing the circulating neutrophil and decreasing reperfusion injury. Dexamethasone is easily available for clinical use, and its use should be considered in cases of prolonged ischemia in skin flaps.