From the Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S356-S358. doi: 10.1097/SAP.0000000000003339. Epub 2022 Dec 8.
Topical nitroglycerine (nitropaste) is an agent that has seen popularization in plastic surgery in recent years. A low-cost medication functioning, by inducing vasodilation primarily in the venous system and inhibiting platelet aggregation, has shown the ability to provide benefits in clinically concerning skin flaps. In random-pattern skin flaps, research shows that topical nitroglycerine decreases flap loss and increases the percentage of viable tissue. In mastectomy skin flaps, there have been multiple studies showing significant decreases in flap necrosis and need for debridement in patients undergoing topical nitroglycerine application without changes in complications profiles. These studies have included patients undergoing and not undergoing implant-based breast reconstruction. There are no data examining myocutaneous or perforator flaps. In free flaps, there is research showing benefit of nitroglycerine in breaking vasospasm and inducing vasodilation in microsurgery. Overall, topical nitroglycerine is a proven entity effective at increasing viable tissue in random-pattern skin flaps and shows clear benefits in the reduction of mastectomy skin flap necrosis with minimal adverse effects or additional cost. Further research is needed into other areas of plastic surgery where it may be of value.
近年来，局部硝酸甘油（硝酸膏）作为一种药物在整形美容领域得到了广泛应用。这种低成本药物主要通过扩张静脉系统和抑制血小板聚集来发挥作用，已被证明能为临床关注的皮瓣带来益处。在随意皮瓣中，研究表明局部硝酸甘油可减少皮瓣坏死并增加存活组织的比例。在乳房切除术皮瓣中，多项研究表明，接受局部硝酸甘油治疗的患者皮瓣坏死的发生率显著降低，需要清创的比例也降低，而并发症发生率没有变化。这些研究包括接受和不接受基于植入物的乳房重建的患者。目前尚无关于肌皮瓣或穿支皮瓣的数据。在游离皮瓣中，有研究表明硝酸甘油在微外科中打破血管痉挛和诱导血管扩张方面具有益处。总的来说，局部硝酸甘油已被证实可有效增加随意皮瓣的存活组织，并在减少乳房切除术皮瓣坏死方面具有明显益处，同时副作用极小或无额外费用。需要进一步研究其在整形美容其他领域的应用价值。
