[Experimental studies of the no-reflow phenomenon with prostacyclin]

The no-reflow phenomenon is a dreaded complication in free tissue transplantations. After a critical period of warm ischemia, insufficient reflow is observed after vessel anastomosis and opening of the artery. In an experimental study in 72 rats, groin flaps were harvested with the nutrient superficial epigastric vessels and transplanted to the neck using a microvascular technique with anastomoses to the carotid artery and jugular vein. Before transplantation, the isolated flaps were perfused either with saline solution, with Iloprost, with and without heparin, or the nutrient vessels were simply flushed with heparin solution. After saline perfusion, there was no venous reflow, after pure Iloprost perfusion, there was venous return in 26% of the flaps, after Heparin-Iloprost perfusion in 88% and after flushing with heparin alone in 93%. The addition of heparin to Iloprost seems to improve the reflow rate. The most effective protection against a no-reflow phenomenon, however, is flushing the nutrient vessels with a heparin solution.