The effect of enoxaparin and clopidogrel on survival of random skin flap in rat animal model.
BACKGROUND
Necrosis of skin flaps is considered as an important complication in reconstructive surgery. We conducted an experimental study to investigate the efficacy of low-molecular weight heparin, clopidogrel and their combination to improve the flap survival.


METHODS
Forty male, adult Sprague-Dawlay rats were divided randomly into 4 groups. Standard rectangular, distally based dorsal random pattern skin flap was elevated. To prevent the graft effect, a sterile sheet was put under the flap. No pharmacological agent was administered for the control group. In group 2, single subcutaneous dose of enoxaparin (3.2 mg/kg) was immediately administrated after surgery. In group 3, clopidogrel (25 mg/kg) was given orally for 7 days. In group 4, both enoxaparin and clopidogrel were administrated. The rats were evaluated on post-operative day 7 for viable and necrotic portions of flaps.


RESULTS
The mean and SD of necrosis was 17.79+2.5 cm in the control group, 16.20±3.1 cm in low-molecular weight heparin, 15.25+3.8 cm in combined therapy group and 13.69+2.7 cm in clopidogrel group. Clopidogrel was the only pharmaceutical agent that produced a significant increase in the flap survival area.


CONCLUSIONS
Clopidogrel may be an effective pharmaceutical agent that significantly increases viability of random skin flaps in rats, but low-molecular weight heparin and their combination did not have any significant beneficial effects.
Associate Professor of Department of Plastic Surgery, Burn Research Center, Hazrate Fatemeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Javad
MJ
Fatemi
Associate Professor of Department of Plastic Surgery, Burn Research Center, Hazrate Fatemeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Kamal
K
S Forootan
Plastic Surgeon, Vali Asr Police Hospital, Tehran, Iran.
Seyed Ziaaddin
SZ
S Jalali
Department of Community Medicine, Burn Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Seyed Jaber
SJ
Mousavi
Veterinary Surgeon, School of Veterinary Medicine, Tehran University, Tehran, Iran.
Mir Sepehr
MS
Pedram
Clopidogrel; Enoxaparin; Rat; Skin flap; Survival