title: The effects of montelukast on random pattern skin flap survival: An experimental study in rats.
abstract: BACKGROUND
  A variety of methods to improve skin flap survival, including the use of pharmacologic agents, have been intensively investigated. Decreasing neutrophil-mediated inflammation and tissue injury has been reported to be effective in improving flap survival. Montelukast is a selective reversible cysteinyl leukotriene receptor-1 antagonist that has been found to have protective effects against renal ischemia reperfusion injury and burn-induced oxidative injury of the skin in rats. However, its effects on skin flap survival have not been previously reported.
  
  
  OBJECTIVE
  The aim of this study was to investigate the effects of montelukast on neutrophil-mediated random pattern skin flap survival.
  
  
  METHODS
  Male Sprague-Dawley rats weighing 230 to 250 g were randomly divided into 2 groups-the montelukast-treated group and the control group. Caudally based rectangular random pattern skin flaps 3 × 9 cm were elevated on the backs of the rats. The flaps were sutured into their original places. In the montelukast group, 1 mL of solution containing 10 mg/kg montelukast was administered intraperitoneally (IP) 30 minutes before surgery and then daily for 6 days. In the control group, 1 mL of saline was administered IP 30 minutes before surgery and then daily for 6 days. To observe the effects of montelukast, myeloperoxidase (MPO) activity, an index of tissue neutrophil infiltration, was measured from extracted skin tissue 12 hours after flap elevation. Flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area.
  
  
  RESULTS
  Sixteen rats (mean [SD] weight, 240.6 [6.6] g) were equally divided between the 2 groups. All rats survived throughout the study period. Mean (SD) MPO activity in flap tissue was significantly lower in the montelukast group than in the control group (14.57 [2.33] vs 21.28 [4.86] U/g protein; P = 0.005). The percentage of necrotic flap area was significantly lower in the montelukast group than in the control group (17.17 [7.95] vs 37.51 [10.72]; P = 0.001).
  
  
  CONCLUSIONS
  This small, experimental, in vivo animal study found that montelukast was associated with both lower MPO activity and a lower percentage of necrotic random pattern skin flap area. Future studies are needed to clarify these findings.
authors.affiliation: Medical Faculty, Department of Aesthetic, Plastic, and Reconstructive Surgery, Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Kaan
authors.initials: K
authors.lastname: Gideroglu
authors.affiliation: Medical Faculty, Department of Otorhinolaryngology and Head and Neck Surgery, Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Yilmaz
authors.affiliation: Otorhinolaryngology and Head and Neck Surgery Clinics, Haseki Education and Research Hospital, Istanbul, Turkey.
authors.forename: Fadullah
authors.initials: F
authors.lastname: Aksoy
authors.affiliation: Medical Faculty, Department of Biochemistry, Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Guler
authors.initials: G
authors.lastname: Bugdayci
authors.affiliation: Medical Faculty, Department of Orthopedics, Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Husamettin
authors.initials: H
authors.lastname: Cakici
authors.affiliation: Orthopedic Clinic, State Hospital, Bolu, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Hapa
keywords: montelukast; necrosis; skin flap survival