Free flap survival improved by prostacyclin analogues

Free flap transplantations and replantations of extremities are threatened by venous occlusion in the postoperative course. In rats, free autogenous groin flaps were transplanted to the neck using microsurgical techniques. On the first postoperative day, the draining vein of the flap was temporarily clamped. In the control group there was always a total loss of the flaps by haemorrhagic necrosis. The intraarterial flap perfusion by iloprost during the clamping was able to diminish the ischaemic effects; 80% of the flaps survived. The systemic application of iloprost by intravenous infusion reduced the ischaemic effects in a similar way. Serious complications such as intraabdominal bleeding or bleeding in the donor area were seen after intravenous administration. Cicaprost had a similar protective effect on flap ischaemia after intravenous infusion. Flap survival was comparable to iloprost. Severe complications seemed to be less. Prostacyclin analogues were able to diminish damage of secondary ischaemia caused by venous occlusion.