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Richard J. Stewart, MA; Tina Moore; Berkeley Bennett; Matthew Easton; George W. Newton, MD; Kent T. Yamaguchi, MD

Arch Surg. 1994;129(9):982-988.

Abstract
Objective
To determine whether treatment with the combination of hyperbaric oxygen and free-radical scavengers or inhibitors would result in increased skin-flap survival.

Design
An animal model with male Sprague-Dawley rats was used. The flap was a cranial-based dorsal 3x 12-cm random-pattern skin flap that included the panniculus carnosus. Rats were randomly assigned to one of 10 treatment groups.

Interventions
The radical scavengers superoxide dismutase, catalase, and -tocopherol acetate and the inhibitor allopurinol were used to combat or scavenge radicals. Oxygen (100%) treatments were for 90 minutes at 2.5 atm absolute daily.

Main Outcome Measures
At 7 days, the flaps were examined for survival by fluorescein injection. Lipid peroxidation as a measure of tissue damage was measured by thiobarbituric acid—malondialdehyde analysis.

Results
The combination of treatments resulted in significantly increased flap survival compared with untreated controls (P<.05) except in the group treated with allopurinol and hyperbaric oxygen. Lipid peroxidation was inhibited by the superoxide dismutase plus catalase and the -tocopherol treatments but not by treatment with allopurinol.

Conclusion
Moderate doses of radical scavengers or antioxidants coupled with a conservative hyperoxic exposure regimen can result in the increased survival of random-pattern skin flaps.

(Arch Surg. 1994;129:982-988)

Author Affiliations
From the University of California—San Francisco Valley Medical Education Program (Mr Stewart and Dr Yamaguchi), California State University (Ms Moore and Messrs Bennett and Easton), the Department of Surgery, the Valley Medical Center (Drs Yamaguchi and Newton), and the Department of Surgery, the Veterans Affairs Medical Center (Dr Yamaguchi), Fresno.

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