Failure of skin flaps remains a significant clinical problem. The dorsal rat flap, a reliable experimental model, was used to test the efficacy of cimetidine in treating a falling flap. Flaps were elevated in 45 rats divided into three equal groups. Group 1 was a saline control group. Group 2 received cimetidine 250 mg/kg three time a day for 7 days postoperatively, and Group 3 received cimetidine for 1 day before surgery, and then as in Group 2. Necrosis was assessed on the seventh postoperative day. Group 2 had 31.1 ± 1.3 (mean % ± SEM) necrosis, significantly better than saline control animals (p < 0.01) and pretreated animals (p < 0.05). These results suggest the usefulness of cimetidine in ischemic flap surgery.
Get full access to this article
View all access options for this article.
References
1.
KerriganCLDanielRL. Pharmacologic treatment of the failing skin flap. Plast Reconstr Surg1982; 70:541–8.
2.
FinsethFAdelbergMG. Prevention of skin flap necrosis by a course of treatment with vasodilator drug. Plast Reconstr Surg1978; 61:738–43.
3.
EarleASFratianneRBNunezFD. The relationship of hematocrit levels to skin flap survival in the dog. Plast Reconstr Surg1974; 58:341.
4.
RubergRLFalconeRE. Effect of protein depletion on the surviving length in experimental skin flaps. Plast Reconstr Surg1978; 61:581–8.
5.
SasakiGHPangCY. Experimental evidence for involvement of prostaglandin in viability of acute skin flaps: Effects of viability and mode of action. Plast Reconstr Surg1981; 67:335–40.
6.
GoodmanLSGillmanA. The pharmacological basis of therapeutic. New York: MacMillan Publishing Company, 1985: 605–27.
7.
BoykinJVCruteSLHaynesBW. Cimetidine therapy for bum shock: A quantitative assessment. J Trauma1985; 25:864–9.
8.
KaufmanTAngelMFEichenlaubEHLevinMHurwitzDFutrellJW. The salutary effects of the bed on the survival of experimental flaps. Ann Plast Surg1985; 44:64–8.
9.
KhouriRKAngelMFEdstromL. Standardizing the dorsal rat flap. Surg Forum1986; 37:590–2.
10.
KaufmanTEichenlaubEHLevinMHurwitzDJSiegelMI. The sonic digitizer: A rapid and accurate method to assess the size of experimental flaps. Ann Plast Surg1984; 13:211–3.
11.
WalterJBIsraelMS, eds. General pathology. 5th ed.New York: Churchill, 1979.
12.
AngelMFRamasastrySSSwartzWMBasfordREFutrellJW. Free radicals: Basic concepts concerning their chemistry, pathophysiology, and relevance to plastic surgery. Plast Reconstr Surg1987; 79:990–7.
13.
AngelMFRamasastrySSSwartzWM. The critical relationship between free radicals and degrees of ischemia: Evidence for tissue intolerance of marginal perfusion. Plast Reconstr Surg1988; 81:233–9.
14.
PetryJJWorthamKA. The anatomy of the epigastric flap in the experimental rat. Plast Reconstr Surg1984; 74:410–3.
15.
MayJWChaitLAO'BrienBMcCHurleyJV. The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg1978; 61:256–67.
16.
MiltonSH. Experimental studies on island flaps. Plast Reconstr Surg1972; 49:444–7.
17.
McFarlaneRMDeYoungGHenryRH. The design of a pedicle flap to study necrosis and its prevention. Plast Reconstr Surg1965; 35:177–82.
18.
AngelMFRamasastrySSSwartzWMNarayananKBasfordREFutrellJW. Augmentation of skin flap survival with allopurinol. Ann Plast Surg1987; 18:494–8.
KaufmanTAngelMFLevinMEichenlaubEHFutrellJW. The effect of IM ketamine HCL and 2% topical nitroglycerine cream on the survival of experimental flaps. Chir Plastica1984; 8:45–9.
21.
AngelMRSchlerenGJoryszMKnightKKO'BrienBMcC. The beneficial effect of chlorpromazine on dorsal skin flap survival. Ann Plast Surg1989; 23:492–7.
22.
BibiRFerderMStrauchB. Prevention of flap necrosis by chlorpromazine. Plast Reconstr Surg1986; 77:954–7.
23.
MonteiroDSantamoreWPNemirD. The influence of pentoxifylline on skin flap survival. Plast Reconstr Surg1986; 77:277.
24.
NichterLSSobieskMNEdgertonMT. Augmentation of critical skin flap survival following ibuprofen therapy. Ann Plast Surgery1986; 16:305–9.
25.
AngelMFRamasastrySSNarayananKZerbeASwartzWMFutrellJW. Studies on the nature of the flap/bed interaction in rodents—Part II. Morphological and fluorescein kinetic data. Ann Plast Surg1986; 17:434–40.
DeHaanCRStarkRB. Vascular reinforcement of pedicled tissues: Quantitation by arteriography of increase in circulation using histamine iontophoresis. Surg Forum1958; 8:578–80.
31.
OdlandRMCohenJT. Measurement of interstitial compliance in skin flaps. Arch Otolaryngol Head Neck Surg1988; 114:1276–9.
32.
MiltonSHCorbettJL. Failure to increase the survival of experimental skin flaps by histamine and hypertension. Plast Reconstr Surg1969; 43:235–9.
33.
BoykinJVMansonNH. Mechanisms of cimetidine protection following thermal injury. Am J Med1987; 83:76–81.
34.
ZinnerMJZuidemaGDSmithDLMignosaM. The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Obstet Gynecol1981; 153:214–20.
35.
BassoNBagaraniMMateriaAFiolaniSLundariPSperanzoV. Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients. Am J Surg1981; 141:339–41.
36.
KikuchiYOomoriKKizawaIKoichiK. Augmented natural killer activity in ovarian cancer patients treated with cimetidine. Eur J Cancer Clin Oncol1986; 22:1037–43.
37.
RichtsmeierWJEiseleD. In vivo angery teversal with cimetidine in patients with cancers. Arch Otolaryngol Head Neck Surg1986; 112:1072–4.
