Combination therapy for salvaging a failing, experimental skin flap

Area of Science:

• Reconstructive Surgery
• Ischemia-Reperfusion Injury
• Pharmacologic Interventions

Background:

• Failing free flaps are a significant challenge in reconstructive surgery.
• Existing treatments often address single factors of the no-reflow phenomenon.
• The no-reflow phenomenon, a consequence of ischemia, impairs flap survival.

Purpose of the Study:

• To evaluate the efficacy of individual and combination pharmacologic agents as postischemic perfusion washouts.
• To improve free flap survival by addressing multiple causative factors of the no-reflow phenomenon.
• To investigate the impact of superoxide dismutase and urokinase in a rat abdominal skin flap model.

Main Methods:

• Utilized a rat abdominal skin flap model to simulate free flap ischemia.
• Administered postischemic perfusion washouts with lactated Ringer's, superoxide dismutase, and urokinase individually.
• Implemented combination therapy with urokinase followed by superoxide dismutase washout.

Main Results:

• Superoxide dismutase alone and combined urokinase/superoxide dismutase washouts increased flap survival after 18 hours of ischemia (p < 0.001).
• Combined urokinase and superoxide dismutase washouts significantly improved flap survival after 20 hours of ischemia (p < 0.05).
• Combination therapy demonstrated superior outcomes compared to single-agent treatments.

Conclusions:

• Combining a thrombolytic agent (urokinase) with an oxygen free radical scavenger (superoxide dismutase) enhances postischemic free flap survival.
• This multi-targeted approach holds promise for treating clinically failing free flaps.
• The findings suggest a novel therapeutic strategy for mitigating ischemia-reperfusion injury in reconstructive surgery.