The effects of epinephrine and dobutamine on skin flap viability in rats: a randomized double-blind placebo-controlled study.

Abstract

Intraoperative reduction in arterial pressure may cause hypoperfusion of skin flaps, which may increase the risk of flap failure. There is no international consensus regarding the use of vasoactive or inotropic agents to restore or maintain flap perfusion. The purpose of this study was to evaluate the effects of the intraoperative administration of epinephrine and dobutamine on axial-pattern skin flap survival in rats. Fifty-four Sprague Dawley rats were randomized into three groups (n = 18). A tubed axial-pattern skin flap was performed. Animals were randomized to receive an intraperitoneal injection of epinephrine 0.1 mg/kg, dobutamine 0.3 mg/kg, or saline (0.5 ml). The rats were euthanized after 7 days and the viable area of the flap was compared between the groups using a digital imaging and computer software. Seven rats/flaps were excluded from the study due to autocannibalism (n = 3), postoperative tracheal obstruction (n = 2), anesthesia-induced respiratory arrest (n = 1), and abnormal behavior requiring euthanization (n = 1). The mean flap survival was 46% ± 9% in the saline group (n = 17), 41% ± 9% in the epinephrine group (n = 14) (p = 0.088 compared to the saline group), and 54% ± 9% in the dobutamine group (n = 16) (p = 0.02 compared to the saline group and p = 0.001 compared to the epinephrine group). Intraoperative intraperitoneal injection of dobutamine improves skin flap survival in rats, whereas intraperitoneal epinephrine tends to decrease skin flap survival.