Is Nitropaste Effective in Stressed Flaps?

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.