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Dual Preconditioning Effect of Dexamethasone and Epinephrine on TRAM flap Survival in Rats  

Kim, Jae Woo (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Kim, Jun Hyuk (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Ahn, Hyoung Sik (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Shin, Ho Sung (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Choi, Hwan Jun (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Lee, Young Man (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
Publication Information
Archives of Plastic Surgery / v.34, no.2, 2007 , pp. 163-168 More about this Journal
Abstract
Purpose: The flap delay is a widely used technique to increase the flap survival. Dexamethasone is a well-known drug to have a positive impact on the flap survival. The objective of this study is to investigate the dual synergic effect of epinephrine as a chemical delay agent plus dexamethasone on the TRAM flap survival in rat model. Methods: Forty Sparague-Dawley rats were divided into 4 groups evenly and a right inferior epigastic vessel pedicled TRAM flap, sized $5.0{\times}3.0cm$, was elevated on each upper abdomen. In the control group(N=10), 2 ml saline was injected on transverse abdominis muscle for a week before the flap elevation. In surgical delay group(N=10) all superior pedicles and left inferior pedicle were ligated a week before the flap elevation. In epinephrine group (N=10), 1 : 50000 epinephrine mixed saline was injected to transverse abdominis muscle every day for a week before flap elevation. In epinephrine plus dexamethasone group (N=10), the same procedure as that of epinephrine group was conducted for a week and 2.5 ml/kg dexamethasone was injected transverse abdominis muscle 2 hours before the flap elevation. On the seventh day after flap elevation, the survival area of flaps were measured and the vessel numbers in upper dermis of flap were counted through histologic slides. Results: The results were as follows: the mean percentage of the flap survival area of surgical delay group ($60.5{\pm}2.44%$), epinephrine group ($75{\pm}4.43%$), and epinephrine plus dexamethasone group ($87{\pm}1.94%$) were higher than that of the control group ($35{\pm}6.06%$) significantly(p<0.05). In case of the vessel number though histologic slides, epinephrine group ($79.3{\pm}5.57$) and epinephrine plus dexamethasone group ($96.3{\pm}14.05$) were higher than that of the control group ($44.8{\pm}8.82$) significantly(p<0.05), but the surgical delay group ($54{\pm}4.23$) showed no significant difference (p>0.05) compared to that of the control group. Conclusion: The results indicated that epinephrine plus dexamethasone injection before the flap elevation could be used to increase the TRAM flap survival area in rat model.
Keywords
Epinephrine; Dexamethasone; Dual preconditioning effect;
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