title: Prevention of unfavourable effects of cigarette smoke on flap viability using botulinum toxin in random pattern flaps: An experimental study.
abstract: BACKGROUND
  There are numerous clinical and experimental studies reporting unfavourable effects of cigarette smoke on skin flaps.
  
  
  OBJECTIVE
  To investigate whether unfavourable effects of cigarette smoke on flap survival could be reduced by botulinum toxin type A.
  
  
  METHODS
  Twenty-eight male Wistar albino rats (15 months of age, mean weight 210 g [range 180 g to 230 g]) were included. They were divided into four groups of seven animals each. The control group underwent the surgical procedure alone. Surgical procedure was performed after administration of botulinum toxin type A in the botulinum toxin (BTX) group, after exposure to cigarette smoke in the cigarette smoke (CS) group, and after BTX type A administration and exposure to CS in the CS+BTX (CS+BTX) group. Random pattern cutaneous flaps (3 cm × 9 cm) were elevated from the dorsum of all rats. Necrosis area was calculated in percentages (%) using Image J computer software. Tissue samples were examined histopathologically.
  
  
  RESULTS
  The mean necrotic area in the control group (26%) and in the BTX group (21%) were similar (P=0.497), whereas administration of BTX type A significantly decreased flap necrosis area in the rats exposed to CS (the mean necrosis areas were 41.5% in the CS group, and 26% in the CS+BTX group; P<0.001). Histopathological examination findings corroborated the unfavourable effects of CS and preventive effects of BTX type A.
  
  
  CONCLUSIONS
  Preoperative administration of BTX significantly enhanced flap viability in the rats exposed to CS. Further human studies are warranted to verify whether BTX type A could be used as an agent to reduce the risk of flap necrosis in patients who smoke.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey;
authors.forename: Hikmet
authors.initials: H
authors.lastname: Karayel
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey;
authors.forename: Burak
authors.initials: B
authors.lastname: Kaya
authors.affiliation: Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Caydere
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey;
authors.forename: Ahmet
authors.initials: A
authors.lastname: Terzioğlu
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey;
authors.forename: Gürcan
authors.initials: G
authors.lastname: Aslan
keywords: Botulinum toxin type A; Flap; Flap survival; Smoking