Clinical and histopathological effects of topical pentoxifylline on autonomisation processes in rat dorsal randomised skin flaps

Melike Zeynep Kuşçu; Selman Hakkı Altuntas; Özlem Özmen; Simge Garlı

doi:10.2340/jphs.v61.45582

Authors

Melike Zeynep Kuşçu Department of Plastic, Reconstructive and Aesthetic Surgery, Süleyman Demirel University Faculty of Medicine, Isparta, Türkiye
Selman Hakkı Altuntas Department of Plastic, Reconstructive and Aesthetic Surgery, Süleyman Demirel University Faculty of Medicine, Isparta, Türkiye
Özlem Özmen Department of Pathology, Burdur Mehmet Akif Ersoy University Faculty of Veterinary Medicine, Burdur, Türkiye
Simge Garlı Animal Experiments Production and Experimental Research Laboratory, Burdur Mehmet Akif Ersoy University Faculty of Veterinary Medicine, Burdur, Türkiye

DOI:

https://doi.org/10.2340/jphs.v61.45582

Keywords:

Flap autonomisation, flap viability, neoangiogenesis, topical pentoxifylline

Abstract

Background: Staged pedicled skin flaps that require pedicle division are frequently employed in reconstructive surgery, rely on their pedicle for vascular supply following transfer until neovascularisation occurs at the recipient site, a phenomenon referred to as autonomisation (pedicle-independent flap viability following neovascularisation). This study sought to investigate the application of topical pentoxifylline to expedite the autonomisation process.

Methods: Caudal-based skin flaps were surgically created in the dorsal region of 60 Wistar rats. On the fifth day, the bases of the flaps were surgically cut, and the flaps were subsequently monitored for an additional 7 days. The rats were divided into three groups: (1) Control group (Vaseline for 5 + 7 = 12 days), (2) Experimental-1 group (topical pentoxifylline for 5 days + vaseline for 7 days), and (3) Experimental-2 group (topical pentoxifylline for 5 + 7 = 12 days). Flap viability was assessed both macroscopically and microangiographically, and histopathological examinations were conducted.

Results: On day 12, the viable flap areas were 40.7% in the control group, 95.5% in experimental-1 group, and 100.0% in experimental-2 group (p < 0.05). Microangiography was conducted on day 5 and 12, and both experimental groups exhibited markedly greater vascularisation compared to the control group. Histopathological and immunohistochemical analyses revealed that pentoxifylline significantly enhanced angiogenesis, new vessel formation, and epithelisation, while mitigating early-stage inflammation, edema, and late-stage fibrosis (p < 0.05).

Conclusion: The application of topical pentoxifylline significantly promoted angiogenesis, thereby expediting the autonomisation of rat dorsal randomised skin flaps. Consequently, its use in reconstructive surgery may be considered, as it has the potential to reduce reliance on the pedicle, minimise complications, and enhance patient outcomes.

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