ISCHEMIC SKIN FLAPS: WHAT TO USE TO SAVE THEM? A NARRATIVE REVIEW

Abstract

Skin flaps necrosis is an important complication in reconstructive surgeries and implies in more comorbidity to patients and higher costs due to and longer period of dressing and local wound care. This article intends to review physiology of non-ischemic and ischemic flaps and approach the main substances classes investigated to improve ischemic flaps viability. It’s fundamental understanding biochemical events that occur during flap surgery and how neurovascular effect, inflammatory response and reactive oxygen species (ROS) contributes to skin flap necrosis. Many substances have been researched to improve ischemic flaps viability, such as vasodilators, heparinoids, ROS scavengers and others. They presented good results, however most of them were studied in animal models only. Recent studies using gene therapy have obtained really excitant results, however in experimental models. Although a vast number of substances have been researched, Nitroglycerin has been tested in humans can be already used besides its side effects.