GENERAL SURGERY

 

Is transdermal nitroglycerin application effective in preventing and healing flap ischaemia after modified radical mastectomy?

 

 

Suat Kutun^I; Ay Aybala Agac^I; Haluk Ulucanlar^I; Oguz Tarcan^I; Ahmet Ay^I; Mete Aldan^II; Guven Gorkem^III; Abdullah Demir^IV; Abdullah Cetin^V

^IM.D.; Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey
^IIM.D.; Ankara Research and Education Hospital, Turkey
^IIIM.D.; Ankara Bilgi Hospital, Turkey
^IVM.D.; Department of General Surgery, Ankara Oncology Research and Training Hospital
^VM.D.; Ph.D. Department of General Surgery, Ankara Oncology Research and Training Hospital

 

 

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ABSTRACT

OBJECTIVE: We evaluated the efficacy of local nitroglycerin application in preventing and treating flap complications after modified radical mastectomy in a large patient cohort.
PATIENTS AND METHODS: Between 1993 and 2008, 6 426 patients undergoing surgery for stage II breast cancer were enrolled in this prospective study. Patients were randomised into treatment and control groups. In the treatment group a nitroglycerin preparation (Nitroderm) was applied to the flap area. Major complications, recovery periods, menopausal status, additional diseases (diabetes mellitus, hypertension, atherosclerotic heart disease) and adverse effects related to nitroglycerin use were recorded.
RESULTS: The recovery rate without major complications was statistically significantly higher in the nitroglycerin-treated group than in the controls (p<0.001).
CONCLUSION: Our results indicate that topical nitroglycerin reduces flap complications after breast surgery.

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REFERENCES

1. Zhang J, Lipa J, Black C, et al. Pharmacological characterization of vasomotor activity of human musculocutaneous perforation artery and vein. J Appl Physiol 2000; 89: 2268-2275.         [ Links ]

2. Nichter L, Sobieski M, Edgerton M. Efficacy of topical nitroglycerine for random-pattern skin-flap salvage. Plast Reconstr Surg 1985; 75(6): 847852.         [ Links ]

3. Gribbe Ö, Samuelson UE, Wiklund NP. Effect of nitric oxide synthase inhibition on blood flow and survival in experimental skin flap. J Plast Reconstr Aesthet Surg 2007; 60: 287-293.         [ Links ]

4. Kane AJ, Barker JE, Mitchell GM. Inducible nitric oxide synthase (NOS) activity promotes ischemic skin flap survival. Br J Pharmacol 2001; 132: 1631-1638.         [ Links ]

5. Waters LM, Pearl RM, Macualay RM. A comparative analysis of the ability of five classes of pharmacological agents to augment skin flap survival in various models and species: an attempt to standardize skin flap research. Ann Plast Surg 1989; 23(2): 117-122.         [ Links ]

6. Özyazgan I, Özköse M, Baçkol G. Nitric oxide in flow-through venous flaps and effects of L-arginine and nitro L-arginine methyl ester (L-NAME) on nitric oxide and flap survival in rabbits. Ann Plast Surg 2007; 59: 550-557.         [ Links ]

7. Gatti JE, Brousseau DA, Silverman DG, LaRossa D. Intravenous nitroglycerine as a means of improving ischemic tissue hemodinamics and survival. Ann Plast Surg 1986; 16(6): 521-526.         [ Links ]

8. Rogers RA, Riviere JE. Pharmacologic modulation of the cutaneous vasculature in the isolated perfused porcine skin flap. J Pharm Sci 1994; 83(12): 1682-1689.         [ Links ]

9. Price MA, Pearl RM. Multiagent pharmacotherapy to enhance skin flap survival: lack of additive effect of nitroglycerine and allopurinol. Ann Plast Surg 1994; 33: 52-56.         [ Links ]

10. Davis RE, Wachholz JH, Jassir D, Perlyn CA, Agrama MH. Comparison of topical anti-ischemic agents in the salvage of failing random pattern skin flaps in rats. Arch Facial Plast Surg 1999; 1: 27-32.         [ Links ]

11. Rorich RJ, Chery GW, Spira M. Enhancement of skin flap survival using nitroglycerin ointment. Plast Reconstr Surg 1984; 73(6): 943-948.         [ Links ]

12. Scheuer S, Hanna MK. Effect of nitroglycerin ointment on penile skin flap survival in hypospadias repair. Urology 1986; 27(5): 87-95.         [ Links ]

13. Fan Z, He J. Preventing necrosis of the skin flaps with nitroglycerin after radical resection for breast cancer. J Surg Oncol 1993; 53: 210.         [ Links ]

14. Dunn LC, Brodland DG, Griego RD, et al. A single postoperative application of nitroglycerin ointment does not increase survival of cutaneous flaps and grafts. Dermatol Surg 2000; 26: 425-427.         [ Links ]

15. Scholefield JH, Bock JU, Marla B, et al. A dose finding study with 0.1%, 0.2% and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures. Gut 2003; 52: 264-269.         [ Links ]