Pharmacological enhancement of cutaneous flap survival with topical dimethyl sulphoxide and hydrogen peroxide

The present study was designed to investigate, in a rabbit model, the value of topical application of a solution of hydrogen peroxide (H2O2) 8% + dimethyl sulphoxide (DMSO) 50% in order to reduce ischaemic failure in random skin flaps. Two parallel, cephalad-based para-midline random cutaneous flap (10 cm x 2.5 cm) were elevated and resutured in place on the dorsum of 40 New Zealand rabbits. The 80 flaps thus obtained were then randomly divided into one control group and three experimental groups of 20 flaps each. Flaps from the control group (Group A) were topically treated with saline, while flaps from experimental Group B were treated with H2O2 8%, flaps from experimental Group C with DMSO 50%, and flaps from experimental Group D with a solution of 50% DMSO + 8% H2O2. Each solution was topically applied to the flaps, 20 ml three times a day for 7 days, starting in the immediate postoperative period. Transcutaneous oxygen tension (PtcO2) measurements were carried out in all flaps 72 h after flap elevation. The percentage of surviving skin area of each flap was determined by planimetry 7 days after flap elevation. The mean surviving area of the Group A (control) flaps was 71%, the mean surviving area of the Group B (H2O2-treated) flaps was 72%, the mean surviving area of the Group C (DMSO-treated) flaps was 76%, and that of the Group D (DMSO+H2O2-treated) flaps was 92%. While no statistically significant differences were found between the survival rates of both the flaps treated with H2O2 or DMSO alone and that of the control group, the mean surviving rate of the DMSO+H2O2 treated flaps (+20%) was statistically higher than that of the control flaps. Similarly, a statistically significant difference has been found between the mean PtcO2 values of the DMSO+H2O2 flaps and those of the other three groups of flaps.