Partial necrosis of a skin flap can complicate reconstructive surgery. We performed a double-blinded crossover study to determine if pentoxifylline improves perfusion and survival of a myocutaneous flap. Ten 20-kg pigs were fed pentoxifylline (400 mg three times a day) or placebo for 1 week before and after raising a 5 x 30 cm panniculus carnosus flap on one flank. After 1 week of washout, each pig began the opposite drug treatment and the surgery was repeated on the opposite flank. Immediately after surgery, perfusion dermofluorometry and laser Doppler velocimetry demonstrated a significant increase in the perfusion of pentoxifylline-treated flaps compared to control flaps. On postoperative day 7, the mean area of clinical necrosis was 39.7 ± 4.7 cm2 on the placebo sides and 30.1 ± 4.6 cm2 on the pentoxifylline sides (t = 2.21, p < 0.05). We conclude that pentoxifylline improves perfusion and survival of myocutaneous flaps in pigs. Clinical trials appear to be indicated on the basis of the findings of this experiment.
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