Rat and pig skin flaps were used to investigate the effects of topical nitroglycerin ointment on flap survival. Significant increase in flap survival was detected and correlated well with plasma nitroglycerin levels measured during the treatment regimen. The drug was applied 1 hour preoperatively in both models. Recent experimental clinical investigations on the use of pharmacologies for treating failing flaps were reviewed, including the possible mechanism of action of nitroglycerin. Characteristics of an ideal pharmacologic agent for use in the treatment of failing flaps were delineated. Further investigation is warranted to determine the effects of nitroglycerin ointment on various other flaps, including musculocutaneous and free flaps, as well as timing of these applications. All these variables could best be studied in the pig with confirmation of other researchers prior to advocating clinical usage. Until then, the ideal pharmacologic agent for prevention of skin-flap necrosis remains unknown.
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