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Volume 2024, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications.

A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method.

Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I2 = 96%, p-value < 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I2 = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study.

Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered.

© 2024 Altam, Al-Siaghi, Alsaaidi, Ahmed, Alhajami, Al-Kubati et al., Licensee HBKU Press.
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2024-03-04
2024-04-28
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Effect of topical nitroglycerin application on flap survival and complications post reconstructive microsurgery: A systematic review and meta-analysis study of the literature
Journal of Emergency Medicine, Trauma and Acute Care 2024, 2 (2024); https://doi.org/10.5339/jemtac.2024.2
/content/journals/10.5339/jemtac.2024.2
/content/journals/10.5339/jemtac.2024.2
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  • Article Type: Research Article
Keyword(s): flap necrosis, flap surgerys, microsurgery, nitroglycerine, reconstructive surgery and topical vasodilators

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