The beneficial antiinflammatory effect of dexamethasone administration prior to reperfusion on the viability of cold-stored skin flaps.

The main purpose of this study was to investigate the possible protective effect of a single dose of glucocorticoid dexamethasone administered just before reperfusion on the viability of cold-stored inferior epigastric rat skin flaps. We also sought evidence for the antiinflammatory mechanism of action of dexamethasone involved in this model of cold ischemia-reperfusion. The viability of flaps on reperfusion day 7, after 1, 2, 3, 4, or 5 days of cold ischemia, was 80, 74, 60, 47 and 12% respectively. Four days' cold ischemia time was chosen to test the effect of intraperitoneal dexamethasone administration (2.5 mg/kg) 30 min prior to reperfusion. Flap survival after 4 days' cold ischemia/7 days' reperfusion increased significantly from a mean of 37.0% survival in saline-treated controls to 73.3% in dexamethasone-treated rats (p < 0.05). Dexamethasone treatment also resulted in significantly lower skin flap water content (a measure of edema) and myeloperoxidase activity (an indicator of neutrophil infiltration) but had no significant effect on skin levels of hydroperoxides (a measure of free radical activity). In conclusion, dexamethasone attenuates ischemia-reperfusion injury in cold-stored skin flaps by reducing the tissue levels of several proinflammatory mediators.