Pharmacologic and surgical enhancement of composite graft survival

A previously described rabbit ear model was used to address the following issues: (1) the role of surgical delay in composite tissue transfer, (2) optimal enhancement of graft survival using the corticosteroid methylprednisolone, (3) pharmacologic salvage of the failing composite graft, and (4) efficacy of a nonsteroidal dual cyclooxygenase/lipooxygenase inhibitor (SK&F 86002) in enhancing graft survival. Preoperative and immediate postoperative steroid treatment groups exhibited a significant improvement in graft survival area compared with the untreated control group. Preoperative initiation of steroid therapy was more effective than a strictly postoperative regimen. SK&F 86002, advance preparation of the recipient bed, and delayed steroid administration did not improve graft survival compared with the untreated control group. The most promising treatment, preoperative initiation of steroid therapy, was further evaluated in a double-blinded placebo-controlled study. The steroid group demonstrated a significantly improved mean survival area, as well as mean graft weight, compared with the placebo control group.